CMS Price Transparency Data

Total hip replacement

Facility: Adventist Health St Helena

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,511
Cash Discount Price: $133
vs. Medicare Baseline: 0.12x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Adventist Health St Helena is $1,511. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.12x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$133

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,511

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: $133 (1%)

Insurance Median: $1,511 (12%)

Cash: $133 (1% of Medicare)

Ins. Median: $1,511 (12% 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
Phcs-All Plans	$364 - $2,672	3%
Health Management Network-All Plans	$562 - $4,129	4%
Three Rivers-All Plans	$595 - $4,372	5%
Blue Shield Bh Mcr Adv	$1,259	10%
Blue Shield Mcr Adv	$1,259	10%
Kaiser Mcr Adv	$1,259	10%
Tricare	$1,259	10%
Ah Employee Health Plan - All Plans	$1,385	11%
Interplan-All Plans	$1,511	12%
Kaiser-All Other Plans	$1,511	12%
Cigna	$1,654	13%
UnitedHealthcare	$1,786	14%
Western Growers-All Plans	$1,801	14%
Aetna	$2,085	16%
Blue Shield Epn-All Other Plans	$2,301	18%
Blue Shield Non-Epn	$2,431	19%
Blue Cross Blue Shield	$3,278	25%

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 $133.
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 Adventist Health St Helena 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.