healthcosts.net
Reconstruction knee at mercy hospital
1320 Mercy Drive Northwest, Canton, OH · Cleveland Clinic · · NPI 1366433195
$4,050.80
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$6,232.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$1.10 with Zing Health vs $22,471.68 with MMO — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| Zing Health | Medicare Advantage | $1.10 | ↓ -100% |
| Summacare | Preferred | $691.20 | ↓ -83% |
| Summacare | Medicare Advantage Lower Level | $691.20 | ↓ -83% |
| Summacare | Medicare Advantage Psych | $756.99 | ↓ -81% |
| United | Managed Medicaid | $801.23 | ↓ -80% |
| Caresource | Managed Medicaid | $825.27 | ↓ -80% |
| Buckeye | Managed Medicaid | $841.29 | ↓ -79% |
| AmeriHealth | Managed Medicaid | $881.35 | ↓ -78% |
| Molina | Managed Medicaid | $881.35 | ↓ -78% |
| Summacare | Medicare Advantage CNA | $903.88 | ↓ -78% |
| Anthem | Medicare Advantage | $1,009.32 | ↓ -75% |
| United | Medicare Advantage | $1,009.32 | ↓ -75% |
| Humana | Medicare Advantage HMO | $1,009.32 | ↓ -75% |
| The Health Plan | Medicare Advantage | $1,009.32 | ↓ -75% |
| Cigna | Medicare Advantage | $1,009.32 | ↓ -75% |
| Aetna | Medicare Advantage | $1,009.32 | ↓ -75% |
| Summacare | Medicare Advantage MD | $1,010.22 | ↓ -75% |
| MMO | Medicare HMO & PPO | $1,039.60 | ↓ -74% |
| Summacare | Premier | $1,059.79 | ↓ -74% |
| CommuniCare | Medicare Advantage | $1,059.79 | ↓ -74% |
| Perennial Health | Medicare Advantage | $1,090.07 | ↓ -73% |
| The Health Plan | All Products PCP | $1,110.25 | ↓ -73% |
| The Health Plan | All Products Specialty Physicians | $1,160.72 | ↓ -71% |
| The Health Plan | All Products Radiation Oncology Physicians | $1,312.12 | ↓ -68% |
| Anthem | All Products Mid-Level Non-Facility | $1,495.14 | ↓ -63% |
| Oscar | All Products | $1,583.55 | ↓ -61% |
| Aultcare | PPO/HMO | $2,231.06 | ↓ -45% |
| OHCP | All Products | $2,424.25 | ↓ -40% |
| United | All Products - Mid-Level | $2,490.97 | ↓ -39% |
| United | All Products | $2,767.74 | ↓ -32% |
| United | HMO & PPO | $2,767.74 | ↓ -32% |
| OMAS | All Products | $3,116.00 | ↓ -23% |
| PHPHI | All Products | $3,739.20 | ↓ -8% |
| UNITED | Managed Medicaid | $4,350.18 | ↑ +7% |
| GMS | All Products | $4,362.40 | ↑ +8% |
| MMO | Traditional | $4,362.40 | ↑ +8% |
| CARESOURCE | Managed Medicaid | $4,480.69 | ↑ +11% |
| ANTHEM | Managed Medicaid | $4,567.69 | ↑ +13% |
| MOLINA | Managed Medicaid | $4,567.69 | ↑ +13% |
| Immergrun | All Products | $4,674.00 | ↑ +15% |
| Aetna | All Products First Health | $4,674.00 | ↑ +15% |
| AMERIHEALTH | Managed Medicaid | $4,785.20 | ↑ +18% |
| Aetna | Asa | $4,985.60 | ↑ +23% |
| Multiplan | All Products | $5,608.80 | ↑ +38% |
| Aetna | Qhp/Ifp | $6,232.00 | ↑ +54% |
| The Health Plan | MEDICARE ADVANTAGE | $10,699.82 | ↑ +164% |
| HUMANA | Medicare Advantage HMO | $11,888.68 | ↑ +193% |
| UNITED | MEDICARE ADVANTAGE | $11,888.68 | ↑ +193% |
| Summacare | MEDICARE ADVANTAGE | $12,146.38 | ↑ +200% |
| ANTHEM | MEDICARE ADVANTAGE | $12,146.38 | ↑ +200% |
| AETNA | MEDICARE ADVANTAGE | $12,146.38 | ↑ +200% |
| CIGNA | MEDICARE ADVANTAGE | $12,510.77 | ↑ +209% |
| CommuniCare | MEDICARE ADVANTAGE | $12,753.70 | ↑ +215% |
| Perennial Health | MEDICARE ADVANTAGE | $12,839.78 | ↑ +217% |
| Perennial Health | HMO I-SNP and HMO C-SNP | $13,118.09 | ↑ +224% |
| MMO | ALL PRODUCTS | $19,917.00 | ↑ +392% |
| MMO | SuperMed | $22,471.68 | ↑ +455% |
| Aetna | ALL PRODUCTS | not published by hospital | — |
| Cigna | All Products Mid-Level | not published by hospital | — |
| Cigna | All Products Physician | not published by hospital | — |
| Aetna | Acop | not published by hospital | — |
Visitor-reported prices
Comments
Reconstruction knee at other Ohio hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| cleveland clinic main campus | Cleveland | $4,050.80 | $1.10 – $12,146.38 |
| akron general | Akron | $4,050.80 | $1.10 – $12,839.78 |
| avon hospital | Avon | not published | $4,541.89 – $13,361.02 |
| cleveland clinic childrens hospital for rehabilitation | Cleveland | not published | $7,415.27 – $8,586.11 |
| euclid hospital | Euclid | not published | $4,653.29 – $13,361.02 |
| fairview hospital | Cleveland | not published | $4,371.53 – $13,361.02 |
| lutheran hospital | Cleveland | not published | $4,161.85 – $13,361.02 |
| hillcrest hospital | Mayfield Heights | not published | $4,554.45 – $13,361.02 |