CMS Price Transparency Data

Total hip replacement

Facility: Jones Memorial Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,430
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Jones Memorial Hospital is $1,430. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.11x the Medicare baseline. Located in 191 North Main Street, Wellsville, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,430

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%)

Insurance Median: $1,430 (11%)

Ins. Median: $1,430 (11% 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
Medicaid / KanCare	$580 - $1,286	4%
Blue Cross Blue Shield	$834 - $33,484	6%
Aetna	$1,041 - $18,194	8%
Excellus 2201	$1,041 - $1,553	8%
UnitedHealthcare	$1,151 - $17,164	9%
Medicare (plans)	$1,162 - $25,516	9%
Independent Health 5156	$1,364 - $25,516	10%
Cigna	$1,612 - $26,499	12%
Fidelis 5155	$1,653	13%
Capital District Physicians Health Plan (Cdphp) 5149	$3,131	24%
UPMC Health Plan 5138	$12,873	98%
Total Senior Care 1319	$17,164	131%
Humana	$17,164	131%
Mvp 2900	$26,499	202%
Empire Plan 5179	$30,381	232%

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 $X.
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 Jones Memorial 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.