CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Melrosewakefield Healthcare

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$18,583

about 1.3× the $14,044 Medicare rate · typically $16,611–$27,085

modeled estimate · not a bill or quote

What this hospital charges insurers

$16,850

About the fair price

about $1,733 under the fair price · 1.2× Medicare

Medicare pays $14,044 Fair price $18,583 This hospital $16,850 Cash price $21,312 Hospital's list price $30,446

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 $16,850

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 $18,583 (about 1.3× the $14,044 Medicare rate). Melrosewakefield Healthcare charges insurers about $16,850, or about $21,312 in cash — about the fair price. Located in Melrose, MA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser 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	$16,850 - $17,036	120%
Blue Cross Blue Shieldmajor	$17,036 - $20,552	121%
Aetnamajor	$3,984	28%
Cignamajor	$16,850	120%
Humanamajor	$16,850	120%
Harvard Pilgrim	$16,850	120%
Tufts Health Plan	$6,780 - $28,777	48%
WellSense	$6,780 - $48,921	48%
+ 14 smaller / regional plans	$3,105 - $28,777

Government programs also on file: Medicare, Medicaid, Military & VA.

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 21,312), 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 Melrosewakefield Healthcare 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 Melrosewakefield Healthcare

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.