CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Monmouth Medical Center-Southern Campus

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $28,520
Cash Discount Price: $2,085
vs. Medicare Baseline: 2.03x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Monmouth Medical Center-Southern Campus is $28,520. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,085. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.03x the Medicare baseline. Located in 600 River Ave, Lakewood, NJ.

Cash / Self-Pay

$2,085

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,520

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: $2,085 (15%)

Insurance Median: $28,520 (203%)

Cash: $2,085 (15% of Medicare)

Ins. Median: $28,520 (203% 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 203% of the Medicare baseline (a markup of 103%). 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 - $15,752	13%
Qualcare Inc	$6,640 - $6,966	47%
Blue Cross Blue Shield	$6,690 - $39,631	48%
Aetna	$15,752 - $39,258	112%
Clover	$15,752	112%
Fidelis Care	$15,752	112%
Humana	$15,752	112%
UnitedHealthcare	$16,067 - $38,000	114%
Cigna	$24,047 - $32,182	171%
Emblem Health	$27,800	198%
Amerihealth	$29,239 - $30,965	208%
Wellcare	$31,346	223%

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 $2,085.
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-Southern Campus 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.