CMS Price Transparency Data

Total hip replacement

Facility: The University of Vermont Health Network-Alice Hy

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,259
Cash Discount Price: $5,515
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at The University of Vermont Health Network-Alice Hy is $1,259. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,515. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.10x the Medicare baseline. Located in 133 Park Street, Po Box 729, Malone, NY.

Cash / Self-Pay

$5,515

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,259

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: $5,515 (42%)

Insurance Median: $1,259 (10%)

Cash: $5,515 (42% of Medicare)

Ins. Median: $1,259 (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
Capital District Physicians' Health Plan	$816 - $1,952	6%
UnitedHealthcare	$840 - $9,020	6%
Fidelis Care	$1,019 - $1,379	8%
Humana	$1,019	8%
Mvp	$1,019 - $2,917	8%
Aetna	$1,199 - $1,843	9%
Martins Point	$1,199	9%
Veterans Affairs Community Care Network	$1,199	9%
Blue Cross Blue Shield	$1,226 - $41,636	9%
Choicecare	$1,242 - $1,615	9%
St. Regis	$2,603	20%
Magnacare	$4,412	34%
Highmark Blueshield	$5,405	41%

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 $5,515.
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 The University of Vermont Health Network-Alice Hy 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.