CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Spencer Municipal Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $37,888
Cash Discount Price: $32,475
vs. Medicare Baseline: 2.70x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Spencer Municipal Hospital is $37,888. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32,475. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.70x the Medicare baseline. Located in 1200 1St Avenue East, Spencer, IA.

Cash / Self-Pay

$32,475

Average discount available for prompt cash payment at this facility.

Insurance Median

$37,888

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: $32,475 (231%)

Insurance Median: $37,888 (270%)

Cash: $32,475 (231% of Medicare)

Ins. Median: $37,888 (270% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 270% of the Medicare baseline (a markup of 170%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medicaid / KanCare	$14,843	106%
Medicare (plans)	$14,896 - $15,045	106%
UnitedHealthcare	$14,896 - $38,970	106%
Humana	$15,045 - $41,135	107%
Healthpartners (All)	$34,640	247%
Midlands Choice - Ilcc	$36,805	262%
Midlands Choice - Morton Bldg	$36,805	262%
Coventry - Commercial Hmo	$38,970	277%
Avera Health Plan	$41,135	293%
Coventry - Commercial Ppo	$41,135	293%
First Choice Of Midwest	$41,135	293%
Midlands Choice (All Others)	$41,135	293%
Sanford Health	$41,135	293%

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 $32,475.
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 Spencer Municipal Hospital 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.