CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: The Monroe Clinic

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$19,810

about 1.4× the $14,044 Medicare rate · typically $13,808–$31,859

modeled estimate · not a bill or quote

What this hospital charges insurers

$13,719

Below the fair price — a good deal

about $6,091 under the fair price · 1.0× Medicare

Medicare pays $14,044 Fair price $19,810 This hospital $13,719

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

A typical price — 4 charge more and 4 charge less, among the 9 WI hospitals compared.

Cheapest $13,222 Priciest $15,279

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

A fair price for a Hip or knee replacement (inpatient stay) is about $19,810 (about 1.4× the $14,044 Medicare rate). The Monroe Clinic charges insurers about $13,719 — below the fair price — a good deal. Located in Monroe, WI.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Humana CignaKaiser 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	$13,719 - $30,953	98%
Blue Cross Blue Shieldmajor	$13,719 - $27,967	98%
Aetnamajor	$13,719	98%
Humanamajor	$13,719	98%
Molina	$13,719	98%
Quartz	$27,882	199%
+ 4 smaller / regional plans	$13,719 - $38,370

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 The Monroe Clinic 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 The Monroe Clinic

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

Orthopaedic Hospital of Wisconsin · Glendale $13,222
Thedacare Regional Medical Center - Appleton Inc · Appleton $13,348
Sauk Prairie Hospital · Prairie Du Sac $13,634
Oakleaf Surgical Hospital · Altoona $13,660
Mile Bluff Medical Center · Mauston $13,872
Ascension Sacred Heart Rehabilitation Hospital · Mequon $15,202
Ascension Columbia St Marys Hospital Milwaukee · Milwaukee $15,215
Beloit Health System · Beloit $15,279

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