CMS Price Transparency Data

Total hip replacement

Facility: Saratoga Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,319
Cash Discount Price: $2,013
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Saratoga Hospital is $1,319. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,013. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.10x the Medicare baseline. Located in 211 Church Street, Saratoga Springs, NY.

Cash / Self-Pay

$2,013

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,319

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: $2,013 (15%)

Insurance Median: $1,319 (10%)

Cash: $2,013 (15% of Medicare)

Ins. Median: $1,319 (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 - $23,193	6%
Fidelis	$900 - $15,226	7%
Medicare (plans)	$900 - $1,199	7%
Blue Cross Blue Shield	$989 - $15,987	8%
Tricare	$1,019 - $1,199	8%
Hamaspik	$1,121 - $20,707	9%
Emblem Health Ghi	$1,199 - $1,319	9%
UnitedHealthcare	$1,199 - $4,153	9%
Mvp	$1,207 - $2,281	9%
Aetna	$1,223 - $6,845	9%
Blue Shield Highmark	$1,344 - $1,540	10%
Cigna	$1,885 - $2,281	14%
Mvp Essential Plan	$4,153 - $8,307	32%
Mvp Govt Programs	$4,153	32%
Empire Plan Nyship	$12,490	95%
Emblem	$15,226	116%

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 $2,013.
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 Saratoga 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.