CMS Price Transparency Data

Total hip replacement

Facility: Hospital for Special Surgery

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $60,632
Cash Discount Price: $85,336
vs. Medicare Baseline: 4.62x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Hospital for Special Surgery is $60,632. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85,336. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 4.62x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$85,336

Average discount available for prompt cash payment at this facility.

Insurance Median

$60,632

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: $85,336 (651%)

Insurance Median: $60,632 (462%)

Cash: $85,336 (651% of Medicare)

Ins. Median: $60,632 (462% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 462% of the Medicare baseline (a markup of 362%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$120 - $82,610	1%
Metro Plus	$837 - $1,476	6%
Fidelis	$1,008 - $1,210	8%
Emblem	$1,344 - $5,292	10%
UnitedHealthcare	$1,344 - $76,712	10%
Aetna	$5,768 - $60,632	44%
Cigna	$6,060 - $56,740	46%
Nyship	$6,865	52%
Horizon	$6,887	53%
Emblem Health [1043]	$55,805 - $93,155	425%
Apwu [1016]	$56,740	433%
Nalc [1090]	$56,740	433%
Qualcare [1101]	$56,740	433%
Wellfleet [1361]	$56,740	433%
Christian Brothers [1034]	$60,632	462%
Meritain Health [1085]	$60,632	462%
Nippon Life [1092]	$60,632	462%
Webtpa [1356]	$60,632	462%
Oxford [1096]	$61,508	469%
Connecticare [1039]	$63,415	483%
Geha [1053]	$68,940	526%
Student Resources [1103]	$68,940	526%
Harvard Pilgrim [1057]	$76,712	585%

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 $85,336.
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 Hospital for Special Surgery 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.