CMS Price Transparency Data

Total hip replacement

Facility: Unitypoint Health - Meriter

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $3,846
Cash Discount Price: $8,011
vs. Medicare Baseline: 0.29x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Unitypoint Health - Meriter is $3,846. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,011. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.29x the Medicare baseline. Located in 202 S Park St, Madison, WI.

Cash / Self-Pay

$8,011

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,846

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: $8,011 (61%)

Insurance Median: $3,846 (29%)

Cash: $8,011 (61% of Medicare)

Ins. Median: $3,846 (29% 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
Aspirus	$1,152 - $12,428	9%
Blue Cross Blue Shield	$1,152 - $26,222	9%
Illinicare	$1,152 - $12,428	9%
Prevea 360	$1,152 - $12,428	9%
UnitedHealthcare	$1,152 - $12,428	9%
Humana	$1,209 - $12,428	9%
Meridiancare	$1,209 - $12,428	9%
Cigna	$2,243 - $3,365	17%
Security Health Plan	$2,403 - $3,605	18%
Health Partners Open Network	$2,587	20%
Mercy Care	$2,804 - $4,206	21%
Medical Associates Health Plan	$3,823	29%
Wellmark Uph Self-Funded	$3,846 - $26,222	29%

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 $8,011.
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 Unitypoint Health - Meriter 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.