CMS Price Transparency Data

Total hip replacement

Facility: Trinity Health Muskegon Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $14,112
Cash Discount Price: $33,930
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Trinity Health Muskegon Hospital is $14,112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33,930. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.08x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.

Cash / Self-Pay

$33,930

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,112

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: $33,930 (259%)

Insurance Median: $14,112 (108%)

Cash: $33,930 (259% of Medicare)

Ins. Median: $14,112 (108% 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
U Of M Health Plan	$2,768	21%
Blue Cross Blue Shield	$7,171 - $20,973	55%
Medicaid / KanCare	$7,171 - $7,312	55%
Priority Health	$9,501 - $10,629	72%
Access Health	$9,591	73%
Aetna	$13,427	102%
Blue Care Network Advantage	$13,427	102%
Medicare (plans)	$13,427	102%
Align Senior Care	$13,701	104%
Correctional Recovery	$13,701	104%
Heartland Hospice	$13,701	104%
Hospice Harbor Hospice	$13,701	104%
UnitedHealthcare	$14,112	108%
Longevity Ipa Of Michigan Llc Health Plan Isnp	$15,441	118%
Oscar	$17,537	134%
Molina Marketplace	$17,811	136%
Bcn Domestic	$20,973	160%
Blue Benefit Administrators Of Massachusetts	$20,973	160%
Blue Care Network	$20,973	160%
Blue Distinction Transplant	$20,973	160%
Blue Shield - Ca	$20,973	160%
Blue Shield - Id (Regence)	$20,973	160%
Blue Shield - Ny Highmark Northeastern	$20,973	160%
Blue Shield - Ny Highmark Western	$20,973	160%
Blue Shield - Pa (Highmark)	$20,973	160%
Blue Shield - Wa (Regence)	$20,973	160%
Health Choices	$20,973	160%
Kaiser Domestic	$20,973	160%
Vitalcore	$21,236	162%
Wellpath	$21,236	162%

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 $33,930.
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 Trinity Health Muskegon 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.