CMS Price Transparency Data

Total hip replacement

Facility: M Health Fairview Southdale Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $3,960
Cash Discount Price: $1,593
vs. Medicare Baseline: 0.30x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at M Health Fairview Southdale Hospital is $3,960. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,593. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.30x the Medicare baseline. Located in 6401 France Avenue South, Edina, MN.

Cash / Self-Pay

$1,593

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,960

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: $1,593 (12%)

Insurance Median: $3,960 (30%)

Cash: $1,593 (12% of Medicare)

Ins. Median: $3,960 (30% 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
Health Partners	$858 - $28,957	7%
Itasca Medical Care	$858 - $12,808	7%
Primewest	$858 - $12,808	7%
South Country Health Alliance	$858 - $12,808	7%
Ucare	$875 - $29,432	7%
Medica	$913 - $13,576	7%
Hennepin Health	$970 - $12,959	7%
Blue Cross Blue Shield	$977 - $13,320	7%
Sanford Health Plan	$1,162 - $12,808	9%
Security Health Plan	$1,162 - $12,808	9%
UnitedHealthcare	$1,162 - $12,808	9%
Wellcare	$1,162 - $12,808	9%
America'S Ppo	$3,827 - $3,978	29%
First Health	$4,129	31%
Multiplan	$4,280	33%
Private Healthcare Systems	$4,280	33%
Wisconsin Physician Services	$4,532	35%

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 $1,593.
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 M Health Fairview Southdale Hospital 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.