CMS Price Transparency Data

Total hip replacement

Facility: St Charles Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 27130
  • Insurance Median: $15,226
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.16x Medicare
The contracted insurance negotiated median rate for a Total hip replacement at St Charles Hospital is $15,226. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.16x the Medicare baseline. Located in 200 Belle Terre Road, Port Jefferson, NY.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$15,226

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%)
Insurance Median: $15,226 (116%)
Ins. Median: $15,226 (116% 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.

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
Brighton $2,250 - $5,269 17%
Zadroga $2,850 22%
Affinity Health Plan $4,127 - $9,285 31%
Beacon Health Options $4,127 - $21,317 31%
Beacon Health Strategies $4,127 - $21,317 31%
Centerlight Healthcare $4,127 - $15,226 31%
Elderplan Inc. $4,127 - $15,226 31%
Emblem Health $4,127 - $15,226 31%
Fidelis Care New York $4,127 - $15,226 31%
Health First $4,127 - $34,259 31%
Health Plus $4,127 - $15,226 31%
Independent Health $4,127 - $15,226 31%
Medicaid / KanCare $4,127 31%
Mvp Health Plans $4,127 - $15,226 31%
Senior Whole Health $4,127 - $15,226 31%
UnitedHealthcare $4,127 - $32,595 31%
Blue Cross Blue Shield $14,922 - $32,595 114%
Aetna $15,226 116%
Centers Plan For Healthy Living $15,226 116%
Healthspring $15,226 116%
Liberty Health $15,226 116%
Longevity Health Plan $15,226 116%
Medicare (plans) $15,226 - $15,987 116%
Orthonet - Uniformed Services Family Health Plan $15,226 116%
Pmc $15,226 116%
Tricare $15,226 116%
Universal Healthcare $15,226 116%
Us Family Health Plan $15,226 116%
Veterans Affairs $15,226 116%
Humana $15,531 118%
Agewell New York $15,759 120%
Partners Health Plan $15,987 122%
Wellcare Health Plan Inc $16,749 128%
Local 1199 $17,406 133%
Surest $29,129 222%
Self Pay $32,595 248%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 200 Belle Terre Road, Port Jefferson, NY 11777
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals