CMS Price Transparency Data

Total hip replacement

Facility: Black River Memorial Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,490
Cash Discount Price: $5,270
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Black River Memorial Hospital is $1,490. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,270. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.11x the Medicare baseline. Located in 711 W Adams St, Black River Falls, WI.

Cash / Self-Pay

$5,270

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,490

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: $5,270 (40%)

Insurance Median: $1,490 (11%)

Cash: $5,270 (40% of Medicare)

Ins. Median: $1,490 (11% 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
Blue Cross Blue Shield	$225 - $1,490	2%
Group Health Cooperative Of Eau Claire	$225 - $5,680	2%
My Choice Wisconsin, Inc.	$225 - $1,490	2%
Quartz Health Solutions, Inc	$225 - $5,329	2%
UnitedHealthcare	$225 - $5,680	2%
Humana	$1,152 - $5,446	9%
Security Health Plan	$1,490 - $4,904	11%
The Alliance	$1,490 - $4,978	11%
Corvel	$3,572	27%
Multiplan	$4,469 - $5,680	34%
Triology Health Solutions	$5,270 - $5,563	40%
Medica	$5,470	42%
Association Benefits Solution	$5,563	42%
Family Health Center Of Marshfield	$5,563	42%
First Health Group Corporation	$5,563	42%
Provider Network Of America	$5,563	42%
Cigna	$5,680	43%
Cofinity	$5,680	43%
Coventry Health Care	$5,680	43%
Custom Benefit Administrators	$5,680	43%
Healthpartners, Inc.	$5,680	43%
Wisconsin Physicians Service Insurance Corp	$5,680	43%
Chorus	$5,739	44%

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 $5,270.
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 Black River Memorial 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.