CMS Price Transparency Data

Total hip replacement

Facility: Kaleida Health

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $15,579
Cash Discount Price: $3,931
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Kaleida Health is $15,579. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,931. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.19x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$3,931

Average discount available for prompt cash payment at this facility.

Insurance Median

$15,579

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: $3,931 (30%)

Insurance Median: $15,579 (119%)

Cash: $3,931 (30% of Medicare)

Ins. Median: $15,579 (119% 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
UnitedHealthcare	$160 - $17,389	1%
American Progressive Life & Health	$1,001	8%
Ghi/Emblem Health	$1,439 - $21,636	11%
Ghi/Emblem Health - Wchob	$1,439 - $1,799	11%
Aetna	$1,499 - $16,988	11%
Magnacare	$1,499 - $6,689	11%
Magnacare - Wchob	$1,499 - $6,689	11%
Univera	$2,254 - $22,334	17%
Univera - Wchob	$2,254 - $21,719	17%
Independent Health Association	$9,324 - $25,362	71%
Independent Health Association - Wchob	$9,673 - $25,985	74%
Blue Cross Blue Shield	$10,928 - $59,804	83%
Tricare	$15,225	116%
Wellcare	$16,667	127%
Fidelis	$17,308	132%
Cigna	$18,751 - $22,757	143%

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 $3,931.
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 Kaleida Health 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.