CMS Price Transparency Data

Total hip replacement

Facility: Riverview Medical Center

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $10,822
Cash Discount Price: $14,242
vs. Medicare Baseline: 0.83x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Riverview Medical Center is $10,822. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,242. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.83x the Medicare baseline. Located in One Riverview Plaza, Red Bank, NJ.

Cash / Self-Pay

$14,242

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,822

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: $14,242 (109%)

Insurance Median: $10,822 (83%)

Cash: $14,242 (109% of Medicare)

Ins. Median: $10,822 (83% 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
Horizon	$1,892 - $12,802	14%
Aetna	$2,288 - $15,524	17%
UnitedHealthcare	$2,379 - $27,151	18%
Karna	$2,664	20%
Clover	$2,920	22%
Seoul Medical Group	$3,521	27%
Blue Cross Blue Shield	$3,537 - $14,242	27%
Qualcare	$6,256 - $10,822	48%
Brighton Health Plan	$9,933	76%
Bergen Risk	$12,169	93%
Cigna	$12,980 - $14,240	99%
Activecare First McO	$13,791	105%
Multiplan - PHCS	$13,791	105%
Amerihealth	$13,972 - $15,795	107%
Vaccn	$14,242	109%
Wellcare	$14,242	109%
United Community/Americhoice	$14,954	114%
Oxford	$21,748	166%

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 $14,242.
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 Riverview Medical Center 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.