CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mercyone Des Moines Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $16,445
Cash Discount Price: $55,795
vs. Medicare Baseline: 1.17x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercyone Des Moines Medical Center is $16,445. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55,795. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.17x the Medicare baseline. Located in 1111 6Th Ave, Des Moines, IA.

Cash / Self-Pay

$55,795

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,445

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: $55,795 (397%)

Insurance Median: $16,445 (117%)

Cash: $55,795 (397% of Medicare)

Ins. Median: $16,445 (117% 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
Auxiant	$13,244	94%
Medica	$13,244	94%
Midlands	$13,244	94%
Midlands Choice	$13,244	94%
Aetna	$13,760	98%
Medicare (plans)	$13,760 - $14,321	98%
Blue Cross Blue Shield	$13,897	99%
UnitedHealthcare	$14,035 - $25,971	100%
Iowa Total Care	$16,364	117%
Medicaid / KanCare	$16,525 - $16,589	118%
Oscar	$18,070	129%
Amish Hospital Aid	$18,674	133%
Centivo	$22,156	158%
Geha	$23,328	166%
Ambetter / Centene	$23,588	168%
Claimdoc	$28,221	201%
Nova	$28,221	201%

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 $55,795.
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 Des Moines 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.