CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Lowell General Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,075
Cash Discount Price: $20,322
vs. Medicare Baseline: 1.22x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Lowell General Hospital is $17,075. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20,322. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.22x the Medicare baseline. Located in 295 Varnum Avenue, Lowell, MA.

Cash / Self-Pay

$20,322

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,075

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: $20,322 (145%)

Insurance Median: $17,075 (122%)

Cash: $20,322 (145% of Medicare)

Ins. Median: $17,075 (122% 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
Medicare (plans)	$1,971 - $17,634	14%
Aetna	$3,959 - $17,299	28%
Meritain [100063]	$3,959	28%
Elementcare [450046]	$6,359	45%
Generic Prison [500099]	$6,780 - $11,926	48%
Medicaid / KanCare	$6,780 - $17,634	48%
Middlesex County [500015]	$6,780 - $11,926	48%
Suffolk County [500014]	$6,780 - $11,926	48%
Tewksbury Hospital [950008]	$6,780 - $11,926	48%
Tufts Health Public Plan [350009]	$6,797 - $11,956	48%
Tufts Health Public Plan Connectorcare [100264]	$8,641 - $11,478	62%
Wellsense Clarity Connectorcare [100256]	$8,814 - $18,008	63%
Champva [800006]	$16,850	120%
UnitedHealthcare	$16,850 - $17,634	120%
Veterans Services [800005]	$16,850	120%
Cigna	$17,299 - $29,420	123%
Fallon Senior [450065]	$17,299 - $17,634	123%
Harvard Pilgrim Stride [450060]	$17,299	123%
Humana	$17,299	123%
Martins Point Generations Replacement [450057]	$17,299	123%
Neighborhood Pace [450114]	$17,299	123%
Peak Pace Solutions [450115]	$17,299	123%
Secure Horizons Ma Pffs [450077]	$17,299	123%
Veterans Evaluation Svcs [800004]	$17,299	123%
Blue Cross Blue Shield	$17,634 - $21,251	126%
Commonwealth Care Alliance [450067]	$17,634	126%
Blue Benefits Administrators [100267]	$20,648	147%
Wellpoint [100139]	$24,055	171%
Fallon Health Connectorcare [100260]	$27,509	196%
Fallon Health [100259]	$27,509	196%

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 $20,322.
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 Lowell General Hospital 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.