CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: University of Wi Hospitals & Clinics Authority

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $12,424
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at University of Wi Hospitals & Clinics Authority is $12,424. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 0.88x the Medicare baseline. Located in 600 Highland Avenue, Madison, WI.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,424

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%)

Insurance Median: $12,424 (88%)

Ins. Median: $12,424 (88% 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	$12,362	88%
Blue Cross Blue Shield	$12,362 - $50,094	88%
Humana	$12,362	88%
Medicare (plans)	$12,362 - $12,609	88%
UnitedHealthcare	$12,362	88%
Wps	$21,195 - $38,057	151%
Alliance_Premier_Network	$30,407	217%
Triology	$30,862 - $35,878	220%
Medical_Associates	$31,759	226%
Alliance	$36,491	260%
Health_Payment_Systems	$44,698	318%
Health_Partners_Insurance	$44,851	319%
Security_Health_Plan	$48,367	344%
Cigna	$49,959	356%

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 $X.
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 University of Wi Hospitals & Clinics Authority 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.