CMS Price Transparency Data

Total hip replacement

Facility: St Joseph's University Medical Center Inc

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $2,974
Cash Discount Price: $2,288
vs. Medicare Baseline: 0.23x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at St Joseph's University Medical Center Inc is $2,974. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,288. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.23x the Medicare baseline. Located in 703 Main St, Paterson, NJ.

Cash / Self-Pay

$2,288

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,974

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: $2,288 (17%)

Insurance Median: $2,974 (23%)

Cash: $2,288 (17% of Medicare)

Ins. Median: $2,974 (23% 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
Fidelis Care of New Jersey	$955 - $16,015	7%
UnitedHealthcare	$955 - $15,253	7%
Aetna	$1,274 - $31,115	10%
Ambetter / Centene	$1,274 - $22,879	10%
Amerihealth	$1,274 - $15,253	10%
Clover Health	$1,274 - $15,253	10%
Horizon New Jersey Total Care	$1,274 - $15,253	10%
Wellpoint	$1,274 - $15,253	10%
Blue Cross Blue Shield	$1,603 - $43,431	12%
Multiplan	$1,910	15%
Private Healthcare Systems	$2,974	23%
Consumer Health Network	$3,770	29%
Horizon New Jersey Health	$3,889	30%
Cigna	$4,575	35%
Oxford	$6,310	48%
Longevity Health Plan	$17,541	134%

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 $2,288.
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 St Joseph's University Medical Center Inc 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.