CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Central Florida Lake Monroe Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$18,828

about 1.3× the $14,044 Medicare rate · typically $16,453–$21,399

modeled estimate · not a bill or quote

What this hospital charges insurers

$19,040

About the fair price

about $212 over the fair price · 1.4× Medicare

Medicare pays $14,044 Fair price $18,828 This hospital $19,040

How we calculate the fair BaseRate →

How this hospital compares to other FL hospitals

Highest price of the 9 FL hospitals we have prices for — worth calling around.

Cheapest $9,376 Priciest $19,040

Black dot = this hospital, among the 9 FL hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $18,828 (about 1.3× the $14,044 Medicare rate). Central Florida Lake Monroe Hospital charges insurers about $19,040 — about the fair price. Located in Sanford, FL.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$4,222 - $44,516	30%
Blue Cross Blue Shieldmajor	$17,482 - $46,488	124%
Aetnamajor	$17,742 - $32,806	126%
Cignamajor	$2,834 - $51,371	20%
Humanamajor	$7,247 - $57,973	52%
AvMed	$2,968 - $61,937	21%
Devoted Health	$17,656	126%
Molina	$2,201 - $18,348	16%
Oscar Health	$26,179	186%
Simply Healthcare	$18,820	134%
WellCare	$18,608	132%
WellMed	$16,963	121%
+ 20 smaller / regional plans	$2,348 - $30,909

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Central Florida Lake Monroe Hospital is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Central Florida Lake Monroe Hospital

Compare: Hip or knee replacement (inpatient stay) at other FL hospitals

Palm Beach Gardens Medical Center · Palm Beach Gardens $9,376
Sacred Heart Hospital on the Emerald Coast · Miramar Beach $11,614
Ascension Sacred Heart Gulf · Port Saint Joe $11,774
Sacred Heart Hospital · Pensacola $12,400
Jay Hospital · Jay $14,553
Gulf Breeze Hospital · Gulf Breeze $14,745
Villages Regional Hospital, The · The Villages $15,040
HCA Florida Pasadena Hospital A Part of HCA Florid · Saint Petersburg $15,054

Insurance negotiated median for the same procedure, sorted lowest first.