CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Tufts Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $18,565
Cash Discount Price: $25,927
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Tufts Medical Center is $18,565. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25,927. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.32x the Medicare baseline. Located in 800 Washington Street, Boston, MA.

Cash / Self-Pay

$25,927

Average discount available for prompt cash payment at this facility.

Insurance Median

$18,565

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: $25,927 (185%)

Insurance Median: $18,565 (132%)

Cash: $25,927 (185% of Medicare)

Ins. Median: $18,565 (132% 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
UnitedHealthcare	$4,284 - $24,061	31%
Generic Prison [500099]	$6,958 - $29,533	50%
Medicaid / KanCare	$6,958 - $29,533	50%
Middlesex County [500015]	$6,958 - $29,533	50%
Suffolk County [500014]	$6,958 - $29,533	50%
Tewksbury Hospital [950008]	$6,958 - $29,533	50%
Tufts Health Public Plan [350009]	$6,958 - $29,533	50%
Health Safety Net [500011]	$7,050	50%
Wellsense Clarity Connectorcare [100256]	$9,324 - $44,595	66%
Tufts Health Public Plan Connectorcare [100264]	$10,171 - $50,767	72%
Elementcare [450046]	$12,343	88%
Fallon Senior [450065]	$16,851 - $18,212	120%
Cigna	$18,212	130%
Harvard Pilgrim Stride [450060]	$18,212	130%
Humana	$18,212	130%
Martins Point Generations Replacement [450057]	$18,212	130%
Medicare (plans)	$18,212 - $24,061	130%
Neighborhood Pace [450114]	$18,212	130%
Peak Pace Solutions [450115]	$18,212	130%
Secure Horizons Ma Pffs [450077]	$18,212	130%
Aetna	$18,565 - $31,466	132%
Blue Cross Blue Shield	$18,565 - $23,957	132%
Commonwealth Care Alliance [450067]	$18,565	132%
Veterans Evaluation Svcs [800004]	$23,604	168%
Blue Benefits Administrators [100267]	$23,957	171%
Champva [800006]	$24,061	171%
Veterans Services [800005]	$24,061	171%
Meritain [100063]	$24,414	174%
Wellpoint [100139]	$40,019	285%
Fallon Health Connectorcare [100260]	$43,551	310%
Fallon Health [100259]	$43,551	310%

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 $25,927.
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 Tufts Medical Center 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.