CMS Price Transparency Data

Total hip replacement

Facility: Surgical Institute of Reading

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $16,557
Cash Discount Price: $18,522
vs. Medicare Baseline: 1.26x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Surgical Institute of Reading is $16,557. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18,522. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.26x the Medicare baseline. Located in 2752 Century Boulevard, Wyomissing, PA.

Cash / Self-Pay

$18,522

Average discount available for prompt cash payment at this facility.

Insurance Median

$16,557

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: $18,522 (141%)

Insurance Median: $16,557 (126%)

Cash: $18,522 (141% of Medicare)

Ins. Median: $16,557 (126% 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
Highmark	$1,432	11%
Aetna	$12,540 - $54,288	96%
Bhp	$12,540 - $24,201	96%
Geisinger Health Plan	$12,540 - $18,810	96%
Unison	$12,540	96%
Blue Cross Blue Shield	$13,073	100%
United	$14,305	109%
Devon	$39,244	299%
First Health	$44,477	339%
Tricare	$45,785	349%

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 $18,522.
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 Surgical Institute of Reading 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.