CMS Price Transparency Data

Total hip replacement

Facility: Glens Falls Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,336
Cash Discount Price: $744
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Glens Falls Hospital is $1,336. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $744. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.10x the Medicare baseline. Located in 100 Park Street, Glens Falls, NY.

Cash / Self-Pay

$744

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,336

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: $744 (6%)

Insurance Median: $1,336 (10%)

Cash: $744 (6% of Medicare)

Ins. Median: $1,336 (10% 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
Medicaid / KanCare	$697 - $1,181	5%
Cdphp	$816 - $22,382	6%
Medicare (plans)	$900 - $1,199	7%
UnitedHealthcare	$900 - $9,818	7%
Emblem Health Ghi	$1,019 - $1,199	8%
Tricare	$1,019 - $1,199	8%
Blue Cross Blue Shield	$1,160 - $15,226	9%
Aetna	$1,199 - $1,595	9%
Fidelis	$1,199 - $9,733	9%
Mvp	$1,207 - $8,734	9%
Blue Shield Highmark	$1,344 - $1,510	10%
Cigna	$1,885 - $2,281	14%
Emblem	$10,506	80%
Magnacare	$15,226	116%
Blue Shield	$20,253	154%

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 $744.
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 Glens Falls 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.