CMS Price Transparency Data

Total hip replacement

Facility: Duke University Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,087
Cash Discount Price: $3,391
vs. Medicare Baseline: 0.08x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Duke University Hospital is $1,087. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,391. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.08x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$3,391

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,087

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: $3,391 (26%)

Insurance Median: $1,087 (8%)

Cash: $3,391 (26% of Medicare)

Ins. Median: $1,087 (8% 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
Amerihealth	$536 - $1,073	4%
Blue Cross Blue Shield	$536 - $3,343	4%
Carolina Complete Health	$536 - $1,073	4%
UnitedHealthcare	$536 - $4,227	4%
Aetna	$582 - $2,830	4%
Humana	$602 - $4,130	5%
Cigna	$924 - $3,301	7%
Alliance Health	$1,073	8%
Partners	$1,073	8%
Trillium	$1,073	8%
Piedmont Health	$1,087	8%
Troy Health	$1,087	8%
Voans	$1,087	8%
Liberty	$1,109	8%
Sentara	$2,733	21%

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 $3,391.
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 Duke University 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.