CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mercyone North Iowa Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $16,602
Cash Discount Price: $88,101
vs. Medicare Baseline: 1.18x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercyone North Iowa Medical Center is $16,602. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88,101. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.18x the Medicare baseline. Located in 1000 Fourth Street Sw, Mason City, IA.

Cash / Self-Pay

$88,101

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,602

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%)

Cash / Self-Pay: $88,101 (627%)

Insurance Median: $16,602 (118%)

Cash: $88,101 (627% of Medicare)

Ins. Median: $16,602 (118% 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
Aetna	$14,070	100%
Medicare (plans)	$14,070 - $14,644	100%
Blue Cross Blue Shield	$14,210	101%
UnitedHealthcare	$14,351 - $33,843	102%
Iowa Total Care	$16,408	117%
Medicaid / KanCare	$16,569 - $16,634	118%
Centivo	$17,659	126%
Preferred One	$17,717	126%
Oscar	$18,502	132%
Amish Hospital Aid	$19,095	136%
Ambetter / Centene	$24,119	172%
Claimdoc	$28,857	205%
Nova	$28,857	205%
Geha	$33,843	241%

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 $88,101.
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 Mercyone North Iowa 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.