CMS Price Transparency Data

Total hip replacement

Facility: UPMC Wellsboro

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $10,435
Cash Discount Price: $16,075
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at UPMC Wellsboro is $10,435. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,075. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.80x the Medicare baseline. Located in 32-36 Central Avenue, Wellsboro, PA.

Cash / Self-Pay

$16,075

Average discount available for prompt cash payment at this facility.

Insurance Median

$10,435

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: $16,075 (123%)

Insurance Median: $10,435 (80%)

Cash: $16,075 (123% of Medicare)

Ins. Median: $10,435 (80% 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
Aetna	$821 - $23,122	6%
Blue Cross Blue Shield	$913 - $13,549	7%
Highmark Wholecare (Prev Gateway)	$913 - $5,358	7%
Upmc Health Plan	$931 - $11,681	7%
Cigna	$958 - $5,626	7%
Pa Health & Wellness	$986 - $14,736	8%
UnitedHealthcare	$993 - $22,773	8%
Wirerope Works	$2,537 - $14,896	19%
Geisinger	$3,057 - $17,951	23%
Multiplan	$3,559 - $25,452	27%
America'S Choice	$4,107 - $24,113	31%
Intergroup	$4,107 - $24,113	31%
Upmc Work Partners	$4,895	37%

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 $16,075.
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 UPMC Wellsboro 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.