CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$17,623

about 1.3× the $14,044 Medicare rate · typically $16,714–$21,393

modeled estimate · not a bill or quote

What this hospital charges insurers

$18,221

About the fair price

about $598 over the fair price · 1.3× Medicare

Medicare pays $14,044 Fair price $17,623 This hospital $18,221 Cash price $53,147 Hospital's list price $53,147

How we calculate the fair BaseRate →

How this hospital compares to other MA hospitals

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

Cheapest $12,252 Priciest $18,221

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

A fair price for a Hip or knee replacement (inpatient stay) is about $17,623 (about 1.3× the $14,044 Medicare rate). UMass Memorial Healthalliance Hospitals charges insurers about $18,221, or about $53,147 in cash — about the fair price. Located in Leominster, MA.

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✓ Cigna HumanaKaiser 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	$18,221 - $18,568	130%
Blue Cross Blue Shieldmajor	$18,056	129%
Aetnamajor	$18,221 - $20,609	130%
Cignamajor	$4,268 - $30,765	30%
Harvard Pilgrim	$18,221	130%
Tufts Health Plan	$3,880 - $18,221	28%
+ 11 smaller / regional plans	$1,814 - $26,612

Government programs also on file: Medicare.

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 53,147), 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 UMass Memorial Healthalliance Hospitals 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 UMass Memorial Healthalliance Hospitals

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

The Shriners' Hospital for Children - Boston · Boston $12,252
Beth Israel Deaconess Hospital - Milton · Milton $13,752
Metrowest Medical Center · Framingham $14,509
Heywood Hospital - · Gardner $16,386
Emerson Hospital - · W Concord $16,445
Winchester Hospital · Winchester $16,517
Anna Jaques Hospital · Newburyport $16,740
Holyoke Medical Center · Holyoke $16,772

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