CMS Price Transparency Data

Total hip replacement

Facility: Forks Community Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $8,437
Cash Discount Price: $13,978
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Forks Community Hospital is $8,437. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,978. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.64x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$13,978

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,437

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: $13,978 (107%)

Insurance Median: $8,437 (64%)

Cash: $13,978 (107% of Medicare)

Ins. Median: $8,437 (64% 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
Medicare (plans)	$318	2%
Medicaid / KanCare	$5,601 - $6,871	43%
Coordinated Care (Mco) Mcd-All Plans	$6,050 - $7,002	46%
UnitedHealthcare	$7,209 - $15,936	55%
Community Health Network Mcr-All Other Plans	$7,289 - $8,437	56%
Humana	$7,289 - $8,437	56%
Tricare	$7,289 - $8,437	56%
Triwest-All Plans	$7,289 - $8,437	56%
Ambetter / Centene	$8,455 - $9,786	64%
Wellcare Med Adv - All Plans	$8,455 - $9,786	64%
Regence-All Other Plans	$9,327 - $10,795	71%
Community Health Exchange	$10,529 - $12,186	80%
Molina Commercial-All Other Plans	$14,902 - $17,248	114%
Blue Cross Blue Shield	$15,388 - $17,811	117%
Aetna	$16,198 - $18,748	123%
Cigna	$16,198 - $18,748	123%
First Choice-All Plans	$16,198 - $18,748	123%

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 $13,978.
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 Forks Community 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.