CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Stoughton Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price medium confidence

A fair price for this

$26,600

about 1.9× the $14,044 Medicare rate · typically $13,130–$40,704

modeled estimate · not a bill or quote

What this hospital charges insurers

$21,366

Below the fair price — a good deal

about $5,234 under the fair price · 1.5× Medicare

Medicare pays $14,044 Fair price $26,600 This hospital $21,366 Cash price $38,844 Hospital's list price $70,625

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $13,222 Priciest $21,366

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 $26,600 (about 1.9× the $14,044 Medicare rate). Stoughton Hospital charges insurers about $21,366, or about $38,844 in cash — below the fair price — a good deal. Located in Stoughton, WI.

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	$4,016 - $56,500	29%
Blue Cross Blue Shieldmajor	$61,444	438%
Aetnamajor	$6,265 - $60,032	45%
Cignamajor	$56,500	402%
Humanamajor	$7,109 - $63,563	51%
Dean Health Plan	$7,109 - $33,202	51%
GEHA	$52,969	377%
Health Net	$6,753	48%
Quartz	$7,109 - $18,454	51%
+ 2 smaller / regional plans	$18,139 - $24,278

Government programs also on file: Medicaid, Military & VA.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 38,844), 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 Stoughton 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 Stoughton 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.