CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Cambridge Health Alliance

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $28,896
Cash Discount Price: $15,721
vs. Medicare Baseline: 2.06x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Cambridge Health Alliance is $28,896. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,721. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.06x the Medicare baseline. Located in 1493 Cambridge Street, Cambridge, MA.

Cash / Self-Pay

$15,721

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,896

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: $15,721 (112%)

Insurance Median: $28,896 (206%)

Cash: $15,721 (112% of Medicare)

Ins. Median: $28,896 (206% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 206% of the Medicare baseline (a markup of 106%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Cigna	$3,353 - $28,896	24%
Aarp [40001]	$3,394 - $26,006	24%
Oxford Health [40004]	$3,394	24%
United Medical Resource [40005]	$3,394	24%
UnitedHealthcare	$3,394 - $26,006	24%
Aetna	$3,800 - $28,896	27%
Other Tufts Health Public Plan [75002]	$9,239 - $46,638	66%
Wellpoint [50012]	$12,682	90%
Blue Cross Blue Shield	$28,896	206%
Boston Medical Center - Wellsense [50003]	$28,896	206%
Commonwealth Care Alliance [65001]	$28,896	206%
Elder Service Plan [65002]	$28,896	206%
Health Safety Net [80001]	$28,896	206%
Hphc [20001]	$28,896	206%
Humana	$28,896	206%
Other Commercial Payor [50015]	$28,896	206%
Senior Whole Health [65003]	$28,896	206%
Tufts Health Plan [30001]	$28,896	206%
Champva [85001]	$32,294	230%
Medicare (plans)	$32,294	230%
Other Gov'T Payor [85003]	$32,294	230%
Tricare	$32,294	230%
Fallon [50006]	$38,752	276%

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 $15,721.
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 Cambridge Health Alliance 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.