CMS Price Transparency Data

Total hip replacement

Facility: Adventist Health Lodi Memorial

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,320
Cash Discount Price: $49
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Adventist Health Lodi Memorial is $1,320. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $49. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.10x the Medicare baseline. Located in 975 S Fairmont Avenue, Lodi, CA.

Cash / Self-Pay

$49

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,320

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: $49 (0%)

Insurance Median: $1,320 (10%)

Cash: $49 (0% of Medicare)

Ins. Median: $1,320 (10% 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
Healthnet Mcal	$126	1%
Hp Of San Joaquin Mcal	$126	1%
Alignment Health Plan (Ahp)-All Plans	$1,147	9%
Blue Shield Mcare Adv	$1,147	9%
Healthnet Mcare	$1,147	9%
Hp Of San Joaquin Mcr Adv	$1,147	9%
Humana	$1,147	9%
Knnex Health - All Plans	$1,147	9%
Tricare	$1,147	9%
UnitedHealthcare	$1,147 - $1,786	9%
Hp Healthy Kids Pro Fee	$1,205	9%
Ah Employee Health Plan - All Plans	$1,262	10%
First Health- All Plans	$1,377	10%
Beech Street- All Plans	$1,492	11%
Hp Of San Joaquin Ppo - All Other Plans	$1,492	11%
Multiplan- All Plans	$1,492	11%
Cigna	$1,546	12%
Kaiser Commercial - All Other Plans	$1,549	12%
Kaiser Mcr Adv	$1,549	12%
Networks By Design- All Plans	$1,549	12%
Western Growers- All Plans	$1,641	13%
Healthnet- All Other Plans	$1,672	13%
Aetna	$1,695	13%
Blue Shield Epn - All Other Plans	$2,104	16%
Blue Shield Non-Epn	$2,224	17%
Blue Cross Blue Shield	$2,871	22%

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 $49.
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 Lodi Memorial 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.