CMS Price Transparency Data

Total hip replacement

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $15,577
Cash Discount Price: $57,400
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at UMass Memorial Health - Harrington Hospital is $15,577. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57,400. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.19x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$57,400

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,577

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$13,116.76

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13,116.76 (100%)

Cash / Self-Pay: $57,400 (438%)

Insurance Median: $15,577 (119%)

Cash: $57,400 (438% of Medicare)

Ins. Median: $15,577 (119% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $13,116.76 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
Harvard Pilgrim [10701]	$202 - $242	2%
Hsno/Free Care [10801]	$681	5%
Blue Cross Blue Shield	$10,154 - $16,094	77%
Champva [11001]	$15,280	116%
Cigna	$15,577	119%
Institution [10406]	$15,577	119%
Mgb Mcr [10124]	$15,577	119%
Tufts Us Family [11203]	$15,577	119%
Aetna	$16,356	125%
Commonwealth Care Alliance [10103]	$16,356	125%
Fallon Mcr Supp [20202]	$16,356	125%
Fallon Mcr [10105]	$16,356	125%
Tufts Mcr [10112]	$16,356	125%
UnitedHealthcare	$16,356 - $16,667	125%
Senior Whole Health [10110]	$16,667	127%
Tufts Connectorcare [10507]	$26,496	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 $57,400.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 27130.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UMass Memorial Health - Harrington Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 27130.
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.