OBJECTIVES: The Medicare Comprehensive Care for Joint Replacement (CJR) program will increase the need for hospital to deliver high quality care at a lower cost; managing postsurgical pain with bupivacaine liposomal injectable suspension (BLIS) may contribute to this objective. This study compared total hospital charges and costs for Medicare THA patients with or without BLIS. METHODS: This analysis used hospital chargemaster data from the Premier Database from 2011 to 2015 to identify Medicare patients who received primary THA at the five hospitals with the highest use of BLIS, comparing them to controls from the same hospital without BLIS. Total hospital charges and costs for the THA admission were aggregated for each patient; costs in this database are estimated by Premier using proprietary charge to cost ratios. A descriptive analysis of total hospital charges and costs for THA at each hospital in both study groups was then conducted, calculating overall charge to cost ratios at each hospital. RESULTS: The five study hospitals each had between 187 and 465 BLIS patients (total 1,534) and between 353 and 585 controls (total 2,295). Mean total hospital charges for THA with BLIS were $54,831 ($60,778, $58,758, $35,424, $48,508, $73,251) while estimated costs were $16,168 ($18,210, $12,746, $18,181, $15,803, $15,096), with an overall charge to cost ratio of 3.37 (3.34, 4.61, 1.95, 3.07, 4.85). Without BLIS, mean total hospital charges for THA were $57,304 ($65,617, $59,370, $37,217, $52,215, $83,480) while estimated costs were $16,820 ($20,553, $14,915, $18,854, $16,283, $12,619), with an overall charge to cost ratio of 3.41 (3.19, 3.98, 1.97, 3.21, 6.62). CONCLUSIONS: Despite wide variations in total hospital charges, costs, and charge to cost ratios for Medicare patients undergoing THA at five Premier hospitals, the use of BLIS to manage postsurgical pain was associated with lower total hospital costs.