CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Monroe Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $20,704
Cash Discount Price: $15,073
vs. Medicare Baseline: 1.47x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Monroe Hospital is $20,704. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,073. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.47x the Medicare baseline. Located in 4011 S Monroe Medical Park Blvd, Bloomington, IN.

Cash / Self-Pay

$15,073

Average discount available for prompt cash payment at this facility.

Insurance Median

$20,704

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: $15,073 (107%)

Insurance Median: $20,704 (147%)

Cash: $15,073 (107% of Medicare)

Ins. Median: $20,704 (147% 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
Aetna	$15,074	107%
Blue Cross Blue Shield	$15,074 - $27,133	107%
Care Source	$15,074 - $21,857	107%
Medicare (plans)	$15,074	107%
UnitedHealthcare	$15,074 - $26,922	107%
Usa Senior Care Network	$15,074	107%
Worthington Christian Fellowship	$15,074	107%
Monroe Medical Group And Managed Health Services	$15,375 - $20,350	109%
Southeastern Indiana Health Operations	$16,015 - $17,083	114%
Provider Partners Health Plan	$16,581	118%
Employer Direct Healthcare	$19,596	140%
Tricare	$21,058	150%
Independent Medical Solutions (Ims) Commercial	$24,118	172%
Corvel Workers Compensation	$26,228	187%
Zelis Healthcare Fka Stratose	$28,640	204%
Americas Choice Provider Network Acpn	$29,243	208%
Multiplan	$29,243	208%
Prime Health Services	$29,243	208%
Three Rivers	$29,243	208%
Encore Health Network Workers Compensation	$29,545	210%
Provider Select	$29,846	213%
Provider Network Of America	$30,147	215%
Workers Compensation	$30,147	215%

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 $15,073.
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 Monroe 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.