CMS Price Transparency Data

Total hip replacement

Facility: Adventist Health Sonora

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,147
Cash Discount Price: $420
vs. Medicare Baseline: 0.09x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Adventist Health Sonora is $1,147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $420. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.09x the Medicare baseline. Located in 1000 Greenley Road, Sonora, CA.

Cash / Self-Pay

$420

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,147

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: $420 (3%)

Insurance Median: $1,147 (9%)

Cash: $420 (3% of Medicare)

Ins. Median: $1,147 (9% 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
UnitedHealthcare	$516 - $3,793	4%
Beech Street- All Plans	$539 - $3,961	4%
Trpn - Three Rivers Ppo - All Plans	$539 - $3,961	4%
Bc Mcal	$599 - $1,489	5%
Celtic Ca Hlth Well Mcal - All Plans	$599 - $1,489	5%
Central Ca Alliance Ccs Mcal	$599 - $2,234	5%
Central Ca Alliance Chdp Mcal	$599 - $2,978	5%
Central Ca Alliance Comm Profee Only-All Other Pla	$599 - $2,234	5%
Central Ca Alliance Mcal	$599 - $1,489	5%
Healthnet Mcal	$599 - $1,489	5%
Medi-Cal	$599 - $1,489	5%
Blue Shield Mcare	$1,147	9%
Central Ca Alliance Mcr Adv Profee Only	$1,147	9%
Healthnet Mcr Adv	$1,147	9%
Tricare	$1,147	9%
Ah Employee Health Plan - All Plans	$1,262	10%
Cigna	$1,411	11%
Greatwest Oa/Pos/Hmo	$1,492	11%
Greatwest Ppo - All Other Plans	$1,492	11%
Western Growers/Pinnacle - All Plans	$1,595	12%
Healthnet - All Other Plans	$1,672	13%
Blue Shield Epn	$2,104	16%
Aetna	$2,152	16%
Blue Shield - All Other Plans	$2,224	17%
Bc Mcs	$2,980	23%
Bc Non-Mcs - All Other Plans	$2,980	23%

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 $420.
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 Sonora 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.