CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Melrosewakefield Healthcare

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $16,850
Cash Discount Price: $21,312
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Melrosewakefield Healthcare is $16,850. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,312. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.20x the Medicare baseline. Located in 585 Lebanon Street, Melrose, MA.

Cash / Self-Pay

$21,312

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,850

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: $21,312 (152%)

Insurance Median: $16,850 (120%)

Cash: $21,312 (152% of Medicare)

Ins. Median: $16,850 (120% 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
Elementcare [450046]	$3,105	22%
Meritain [100063]	$3,984	28%
Generic Prison [500099]	$6,780 - $28,777	48%
Medicaid / KanCare	$6,780 - $30,216	48%
Middlesex County [500015]	$6,780 - $28,777	48%
Suffolk County [500014]	$6,780 - $28,777	48%
Tewksbury Hospital [950008]	$6,780 - $28,777	48%
Tufts Health Public Plan [350009]	$6,780 - $28,777	48%
Wellsense Nh [350010]	$6,780 - $28,777	48%
Wellsense Clarity Connectorcare [100256]	$10,129 - $48,921	72%
Fallon Senior [450065]	$15,774 - $16,850	112%
Champva [800006]	$16,850	120%
Cigna	$16,850	120%
Harvard Pilgrim Stride [450060]	$16,850	120%
Humana	$16,850	120%
Martins Point Generations Replacement [450057]	$16,850	120%
Medicare (plans)	$16,850 - $17,177	120%
Neighborhood Pace [450114]	$16,850	120%
Peak Pace Solutions [450115]	$16,850	120%
Secure Horizons Ma Pffs [450077]	$16,850	120%
UnitedHealthcare	$16,850 - $17,036	120%
Veterans Evaluation Svcs [800004]	$16,850	120%
Veterans Services [800005]	$16,850	120%
Blue Cross Blue Shield	$17,036 - $19,480	121%
Commonwealth Care Alliance [450067]	$17,036	121%
Blue Benefits Administrators [100267]	$19,480	139%
Wellpoint [100139]	$20,552	146%
Fallon Health Connectorcare [100260]	$24,391	174%
Fallon Health [100259]	$24,391	174%
Tufts Health Public Plan Connectorcare [100264]	$28,398	202%

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 $21,312.
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 Melrosewakefield Healthcare 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.