CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,221
Cash Discount Price: $53,147
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at UMass Memorial Healthalliance Hospitals is $18,221. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53,147. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.30x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$53,147

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,221

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%)

Cash / Self-Pay: $53,147 (378%)

Insurance Median: $18,221 (130%)

Cash: $53,147 (378% of Medicare)

Ins. Median: $18,221 (130% 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
Fallon Mcaid Carelon Hlth [29]	$1,814	13%
Fallon Carelon Hlth [28]	$2,023	14%
Hne [11108]	$3,685	26%
Tufts [11201]	$3,880	28%
Cigna	$4,268 - $30,765	30%
Correctional Care [11003]	$17,353 - $23,905	124%
Hsno/Free Care [10801]	$17,816	127%
Institution [10406]	$17,816	127%
Medicare (plans)	$17,816	127%
Tufts Connectorcare [10507]	$17,816	127%
Tufts Dual [10111]	$17,816	127%
Blue Cross Blue Shield	$18,056	129%
Aetna	$18,221 - $20,609	130%
Commonwealth Care Mcr [10115]	$18,221	130%
Fallon Mcr Supp [20202]	$18,221	130%
Harvard Pilgrim Mcr [10106]	$18,221	130%
Mgb Mcr [10124]	$18,221	130%
Tufts Mcr [10112]	$18,221	130%
UnitedHealthcare	$18,221 - $18,568	130%
Senior Whole Health [10110]	$18,568	132%
Fallon Connectorcare [10503]	$22,803	162%
Mgb Hlth Partners [11110]	$23,141 - $26,612	165%

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 $53,147.
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 UMass Memorial Healthalliance Hospitals 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.