CMS Price Transparency Data

Total hip replacement

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $8,911
Cash Discount Price: $3,548
vs. Medicare Baseline: 0.68x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Nationwide Children's Hospital Toledo, LLC is $8,911. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,548. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.68x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$3,548

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,911

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: $3,548 (27%)

Insurance Median: $8,911 (68%)

Cash: $3,548 (27% of Medicare)

Ins. Median: $8,911 (68% 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
Mcclaren Health Plan - Michigan	$854 - $13,510	7%
Caresource	$1,129 - $13,773	9%
Paramount	$1,129	9%
Tricare	$1,158 - $12,223	9%
Blue Cross Blue Shield	$1,186 - $8,997	9%
Front Path Health Coalition	$1,468 - $39,350	11%
Mcclaren Health Plan	$1,581	12%
UnitedHealthcare	$2,006 - $8,911	15%
Aetna	$2,263	17%
Cigna	$4,300	33%
Ohc	$4,436	34%
Ohio Ppo Connect	$4,436	34%
Mmo	$5,914	45%
Molina	$8,911 - $15,440	68%
Amerihealth	$8,997	69%
Bchp	$8,997	69%
Humana	$8,997	69%

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 $3,548.
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 Nationwide Children's Hospital Toledo, LLC 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.