CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mercy St Vincent Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $14,855
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercy St Vincent Medical Center is $14,855. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.06x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,855

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Insurance Median: $14,855 (106%)

Ins. Median: $14,855 (106% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,044.15 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Caresource [2002]	$5,357 - $9,293	38%
Buckeye Community Health Plan [2001]	$5,383 - $9,337	38%
Amerihealth Caritas Oh [4813]	$5,435 - $9,427	39%
Blue Cross Blue Shield	$5,435 - $32,544	39%
Humana	$5,435 - $14,422	39%
Medicaid / KanCare	$5,435 - $9,427	39%
UnitedHealthcare	$5,538 - $54,006	39%
Buckeye Mycare Benefits [4237]	$13,642 - $14,422	97%
Paramount Elite [3723]	$13,642 - $14,422	97%
Aetna	$13,656 - $26,545	97%
Medicare (plans)	$13,914 - $14,711	99%
Caresource Mycare Ohio [4236]	$13,929 - $14,711	99%
Devoted Health Plan [4501]	$14,567 - $16,312	104%
Molina Mycare Ohio [4235]	$15,144	108%
Medigold [4435]	$16,556	118%
Caresource [4179]	$24,007	171%
Meritain Health [3068]	$25,439 - $26,545	181%
Buckeye [4178]	$25,663	183%
Molina Marketplace Aca [4181]	$25,800 - $26,276	184%
Cigna	$28,436 - $36,183	202%
Medical Mutual [3067]	$32,374	231%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $X.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy St Vincent Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 470.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.