CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Mahaska Health Partnership

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $30,619
Cash Discount Price: $52,924
vs. Medicare Baseline: 2.18x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Mahaska Health Partnership is $30,619. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52,924. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.18x the Medicare baseline. Located in 1229 C Avenue East, Oskaloosa, IA.

Cash / Self-Pay

$52,924

Average discount available for prompt cash payment at this facility.

Insurance Median

$30,619

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: $52,924 (377%)

Insurance Median: $30,619 (218%)

Cash: $52,924 (377% of Medicare)

Ins. Median: $30,619 (218% 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 218% of the Medicare baseline (a markup of 118%). 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
Aetna	$15,990 - $60,396	114%
Amerigroup Mcr Adv	$15,990	114%
Humana	$15,990	114%
Iowa Total Care Comm - All Other Plans	$15,990	114%
Iowa Total Care Mcr	$15,990	114%
UnitedHealthcare	$15,990 - $40,160	114%
Medicaid / KanCare	$30,619	218%
Molina Mcaid - All Plans	$30,619	218%
Wellmark Hmo	$30,976	221%
Wellmark Ppo - All Other Plans	$30,976	221%
Midlands Choice - All Plans	$60,396	430%

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 $52,924.
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 Mahaska Health Partnership 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.