CMS Price Transparency Data
Total hip replacement
Facility: Newton Medical Center
Billing Code: 27130 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 27130
- Insurance Median: $14,930
- Cash Discount Price: $15,145
- vs. Medicare Baseline: 1.14x Medicare
The contracted insurance negotiated median rate for a Total hip replacement at Newton Medical Center is $14,930. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,145. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.14x the Medicare baseline. Located in 175 High St, Newton, NJ.
Cash / Self-Pay
$15,145
Average discount available for prompt cash payment at this facility.
Insurance Median
$14,930
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: $15,145 (115%)
Insurance Median: $14,930 (114%)
Cash: $15,145 (115% of Medicare)
Ins. Median: $14,930 (114% 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.
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 |
|---|---|---|
| Wtc Health Program [5273] | $2,589 | 20% |
| Horizon Nj Health [5021] | $3,167 | 24% |
| Blue Cross Blue Shield | $11,952 - $19,625 | 91% |
| Kessler Foundation [5532] | $12,000 | 91% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $14,060 | 107% |
| Karen Ann Quinlan [5285] | $14,060 | 107% |
| Specialty Imaging [5433] | $14,060 | 107% |
| Medicaid / KanCare | $14,060 | 107% |
| Fairos [5491] | $14,060 | 107% |
| Us Family Health Plan [5258] | $14,930 | 114% |
| Amerihealth Administrators Supplemental [5512] | $14,930 | 114% |
| Champva [5354] | $14,930 | 114% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $14,930 | 114% |
| VA Community Care Network [5403] | $14,930 | 114% |
| Highmark Wholecare Health Plan [5413] | $14,930 | 114% |
| Claim Watcher/Homestead [5488] | $14,930 | 114% |
| Sedgwick Wtc Health Program Wc [5514] | $14,930 | 114% |
| Wellcare Health Plans [5269] | $14,930 | 114% |
| Luminare Health AHS Retiree [5013] | $14,930 | 114% |
| Medicare (plans) | $14,930 - $15,452 | 114% |
| Ambetter / Centene | $14,930 | 114% |
| Amerihealth Medigap [5049] | $14,930 | 114% |
| UPMC [5455] | $14,930 | 114% |
| Aetna | $14,930 - $23,084 | 114% |
| Cigna | $14,930 | 114% |
| Claimdoc [5434] | $14,930 | 114% |
| Wellcare Health Plans Ip Splits [5475] | $14,930 | 114% |
| Wellcare Behavioral Health [5335] | $14,930 | 114% |
| Tricare | $14,930 | 114% |
| Amerihealth Caritas Vip Care Ip Splits [5460] | $15,079 | 115% |
| Amerihealth Caritas Vip Care [5313] | $15,079 | 115% |
| Amerihealth [5008] | $15,700 - $16,787 | 120% |
| Kindred Giralda Hospital [5341] | $16,423 | 125% |
| Independence Bc [5479] | $19,625 | 150% |
| Prime Healthcare [5435] | $19,625 | 150% |
| Evolution Healthcare [5438] | $23,084 | 176% |
| Allied Benefit Systems [5046] | $23,084 | 176% |
| Webtpa [5447] | $23,084 | 176% |
| Starmark [5240] | $23,084 | 176% |
| Healthez [5445] | $23,084 | 176% |
| 1199 Seiu Benefit and Pension [5037] | $23,084 | 176% |
| Christian Brothers Services [5439] | $23,084 | 176% |
| Marpai Health [5449] | $23,084 | 176% |
| Nippon Benefit Life [5201] | $23,084 | 176% |
| Healthsmart Benefit Solutions [5446] | $23,084 | 176% |
| Luminare Health Benefits [5483] | $23,084 | 176% |
| Meritain Health [5185] | $23,084 | 176% |
| Banner Health Network [5510] | $23,084 | 176% |
| Continental Assurance [5091] | $23,084 | 176% |
| Boon-Chapman [5441] | $23,084 | 176% |