CMS Price Transparency Data

Total hip replacement

Facility: Stanford Health Care

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,886
Cash Discount Price: $4,722
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Stanford Health Care is $1,886. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,722. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.14x the Medicare baseline. Located in 300 Pasteur Drive, Stanford, CA.

Cash / Self-Pay

$4,722

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,886

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: $4,722 (36%)

Insurance Median: $1,886 (14%)

Cash: $4,722 (36% of Medicare)

Ins. Median: $1,886 (14% 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
Cigna	$201 - $2,218	2%
Beech St [10600]	$259 - $2,426	2%
Claritev [13400]	$259 - $2,426	2%
Kaiser Northern Ca [12900]	$259 - $2,426	2%
Private Healthcare Systems (Phcs) [14200]	$259 - $2,426	2%
Health Plan Of San Mateo [31200]	$261 - $1,955	2%
Healthnet Alt Payer [912100000]	$364 - $2,182	3%
Healthnet [12100]	$364 - $2,182	3%
Blue Card (Out Of State) [40000]	$367 - $3,439	3%
Blue Cross Blue Shield	$367 - $26,317	3%
Shca Comm Intel [20300000]	$367 - $3,439	3%
UnitedHealthcare	$428 - $48,543	3%
Aetna	$457 - $52,916	3%
American Specialty Health Plan Alt Payer [971000000]	$527 - $3,954	4%
Blue Card (Out Of State) - Blue Shield [40200]	$527 - $3,954	4%
Blue Shield Alt Payer [970000000]	$527 - $3,954	4%
Blue Shield [70000]	$527 - $3,954	4%
Psych Blue Shield Alt Payer [970000100]	$527 - $3,954	4%
Healthnet	$18,884	144%
Blue Shield	$39,140	298%

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 $4,722.
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 Stanford Health Care 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.