CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mercyone Centerville Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $3,957
Cash Discount Price: $91,385
vs. Medicare Baseline: 0.28x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mercyone Centerville Medical Center is $3,957. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91,385. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.28x the Medicare baseline. Located in One St Joseph's Drive, Centerville, IA.

Cash / Self-Pay

$91,385

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,957

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: $91,385 (651%)

Insurance Median: $3,957 (28%)

Cash: $91,385 (651% of Medicare)

Ins. Median: $3,957 (28% 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
Medicare (plans)	$2,625 - $3,439	19%
Blue Cross Blue Shield	$3,277	23%
Aetna	$3,311	24%
UnitedHealthcare	$3,510	25%
Amish Hospital Aid	$4,404	31%
Ambetter / Centene	$5,562	40%
Claimdoc	$6,655	47%
Nova	$6,655	47%
Iowa Total Care	$23,695	169%
Medicaid / KanCare	$24,044 - $24,160	171%

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 $91,385.
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 Centerville 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.