CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Cass County Memorial Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $8,751
Cash Discount Price: $25,738
vs. Medicare Baseline: 0.62x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Cass County Memorial Hospital is $8,751. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,738. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.62x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$25,738

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,751

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: $25,738 (183%)

Insurance Median: $8,751 (62%)

Cash: $25,738 (183% of Medicare)

Ins. Median: $8,751 (62% 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
Midlands Choice Medica Mcr	$7,354	52%
Triwest - All Plans	$8,241	59%
Iowa Total Care Comm - All Other Plans	$8,360	60%
Aetna	$8,496 - $34,929	60%
Amerigroup Mcr Adv - All Other Plans	$8,496	60%
Medica Mcr Adv	$8,496	60%
Tricare	$8,496	60%
UnitedHealthcare	$8,496 - $33,385	60%
Va Ccn - All Plans	$8,496	60%
Wellmark Mcr Adv	$8,581	61%
Iowa Total Care Mcr	$8,666	62%
American Hlth Mcr Adv - All Plans	$8,751	62%
Wellmark Hmo	$21,693	154%
Wellmark Ppo - All Other Plans	$21,693	154%
Midlands Choice New Bus	$23,899	170%
Medicaid / KanCare	$31,431	224%
Iowa Total Care Mcaid	$32,059	228%
Molina Mcaid - All Plans	$32,059	228%
Medica Comm - All Other Plans	$32,356	230%
Midlands Choice Pho (Ppo) - All Other Plans	$33,826	241%
Multiplan - All Plans	$34,929	249%

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 $25,738.
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 Cass County Memorial 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.