CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Monmouth Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $30,676
Cash Discount Price: $3,629
vs. Medicare Baseline: 2.18x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Monmouth Medical Center is $30,676. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,629. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.18x the Medicare baseline. Located in 300 Second Avenue, Long Branch, NJ.

Cash / Self-Pay

$3,629

Average discount available for prompt cash payment at this facility.

Insurance Median

$30,676

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: $3,629 (26%)

Insurance Median: $30,676 (218%)

Cash: $3,629 (26% of Medicare)

Ins. Median: $30,676 (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
Wellpoint	$1,885 - $18,876	13%
Qualcare Inc	$6,640 - $6,966	47%
Blue Cross Blue Shield	$6,690 - $39,206	48%
UnitedHealthcare	$16,067 - $38,000	114%
Aetna	$18,876 - $39,258	134%
Clover Health	$18,876	134%
Humana	$18,876	134%
Fidelis Care	$18,876	134%
Cigna	$25,581 - $34,236	182%
Amerihealth	$29,790 - $31,561	212%
Emblem Health	$32,152	229%
Wellcare	$37,563	267%

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 $3,629.
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 Monmouth 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.