CMS Price Transparency Data

Total hip replacement

Facility: Saint Joseph Regional Medical Center

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $25,809
Cash Discount Price: $40,606
vs. Medicare Baseline: 1.97x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Saint Joseph Regional Medical Center is $25,809. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40,606. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.97x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.

Cash / Self-Pay

$40,606

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,809

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: $40,606 (310%)

Insurance Median: $25,809 (197%)

Cash: $40,606 (310% of Medicare)

Ins. Median: $25,809 (197% 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
Aetna	$7,031 - $21,054	54%
Blue Cross Blue Shield	$7,031 - $47,957	54%
Medicaid / KanCare	$7,031 - $26,103	54%
UnitedHealthcare	$7,031 - $26,103	54%
Medicare (plans)	$13,583 - $13,855	104%
Meridian Complete	$13,583	104%
Pace-Trinity Health	$13,583	104%
County Coroner	$14,127	108%
Provider Partners Health Plan Of Indiana	$14,942	114%
Auxiant	$20,375 - $29,204	155%
Physicians Health Plan Northern Indiana Health Insurance	$20,375 - $41,022	155%
St Joseph County Hlth Dpt	$20,375	155%
Caresource	$21,054	161%
Siho Insurance Services	$21,734	166%
Key Benefit Administrator	$24,450 - $29,204	186%
Allied Benefit Systems	$25,809	197%
Managed Health Services - Indiana	$26,103	199%
Mdwise	$26,103	199%
Custom Design Benefits	$29,204	223%
Blue Benefit Administrators Of Massachusetts	$47,957	366%
Blue Care Network	$47,957	366%
Blue Distinction Transplant	$47,957	366%
Blue Shield - Ca	$47,957	366%
Blue Shield - Id (Regence)	$47,957	366%
Blue Shield - Ny Highmark Northeastern	$47,957	366%
Blue Shield - Ny Highmark Western	$47,957	366%
Blue Shield - Pa (Highmark)	$47,957	366%
Blue Shield - Wa (Regence)	$47,957	366%

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 $40,606.
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 Saint Joseph Regional Medical Center 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.