CMS Price Transparency Data

Total hip replacement

Facility: Westfield Memorial Hospital Inc

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,628
Cash Discount Price: $796
vs. Medicare Baseline: 0.12x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Westfield Memorial Hospital Inc is $1,628. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $796. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.12x the Medicare baseline. Located in 189 E Main St, Westfield, NY.

Cash / Self-Pay

$796

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,628

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: $796 (6%)

Insurance Median: $1,628 (12%)

Cash: $796 (6% of Medicare)

Ins. Median: $1,628 (12% 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
Univera	$136 - $1,531	1%
Amerihealth	$210 - $15,987	2%
Pennsylvania Health And Wellness	$264 - $1,320	2%
Geisinger	$290 - $1,450	2%
UnitedHealthcare	$290 - $16,444	2%
Jefferson Health Plans	$1,187	9%
Highmark	$1,582 - $25,248	12%
Cigna	$2,044	16%
Martin'S Point	$3,380 - $15,226	26%
American Health Plans	$15,226	116%
Life Pittsburgh	$15,226	116%
Medicare (plans)	$15,683	120%
Aetna	$15,835 - $29,234	121%
Humana	$16,140	123%
Molina	$16,596	127%

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 $796.
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 Westfield Memorial Hospital Inc 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.