CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Tomah Memorial Hospital

Billing Code: 470 (MS-DRG)

No verified fair price for this procedure here

This hospital only published government or network rates for this billing code — not a standard commercial price — so we can’t show a verified fair-price comparison for it. What it charges each insurer is listed below; call the hospital’s billing office to confirm the actual charge.

modeled estimate · not a bill or quote

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser 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	$12,240 - $78,873	87%
Blue Cross Blue Shieldmajor	$12,240 - $76,950	87%
Aetnamajor	$12,101 - $71,095	86%
Cignamajor	$63,567 - $81,132	453%
Humanamajor	$12,240 - $77,368	87%
Quartz	$12,240 - $75,277	87%
+ 8 smaller / regional plans	$12,240 - $78,622

Government programs also on file: Military & VA.

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 (about 48,094), 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 Tomah Memorial Hospital 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 Tomah Memorial Hospital

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
The Monroe Clinic · Monroe $13,719
Mile Bluff Medical Center · Mauston $13,872
Ascension Sacred Heart Rehabilitation Hospital · Mequon $15,202
Ascension Columbia St Marys Hospital Milwaukee · Milwaukee $15,215

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