CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mercy Regional Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $14,299
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercy Regional Medical Center is $14,299. 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 1.02x the Medicare baseline. Located in 3700 Kolbe Road, Lorain, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,299

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: $14,299 (102%)

Ins. Median: $14,299 (102% 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]	$3,574	25%
Buckeye Community Health Plan [2001]	$3,644	26%
Amerihealth Caritas Oh [4813]	$3,715	26%
Blue Cross Blue Shield	$3,715 - $37,881	26%
Humana	$3,715 - $14,158	26%
Medicaid / KanCare	$3,715	26%
UnitedHealthcare	$3,715 - $32,963	26%
Aetna	$14,158 - $26,642	101%
Buckeye Mycare Benefits [4237]	$14,158	101%
Medigold [4435]	$14,158	101%
Paramount Elite [3723]	$14,158	101%
Devoted Health Plan [4501]	$14,299	102%
Medicare (plans)	$14,299	102%
Caresource Mycare Ohio [4236]	$14,441	103%
Molina Mycare Ohio [4235]	$14,866	106%
Buckeye [4178]	$22,448	160%
Molina Marketplace Aca [4181]	$22,448	160%
Caresource [4179]	$25,345	180%
Meritain Health [3068]	$26,642	190%
Cigna	$31,102	221%
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 Regional 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.