CMS Price Transparency Data

Total hip replacement

Facility: Allegheny General Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,363
Cash Discount Price: $868
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Allegheny General Hospital is $1,363. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $868. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.10x the Medicare baseline. Located in 320 East North Avenue, Pittsburgh, PA.

Cash / Self-Pay

$868

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,363

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: $868 (7%)

Insurance Median: $1,363 (10%)

Cash: $868 (7% of Medicare)

Ins. Median: $1,363 (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
Univera	$136 - $1,531	1%
Amerihealth	$210 - $12,997	2%
Pennsylvania Health And Wellness	$264 - $1,320	2%
Geisinger	$290 - $1,450	2%
UnitedHealthcare	$290 - $43,145	2%
Aetna	$931 - $41,368	7%
Highmark Wholecare	$1,071 - $13,121	8%
Highmark	$1,582 - $12,873	12%
Cigna	$2,044 - $41,071	16%
Martin'S Point	$3,380 - $12,378	26%
American Health Plans	$12,378	94%
Life Pittsburgh	$12,378	94%
Humana	$13,121	100%
Medicare (plans)	$13,121	100%
Molina	$13,492	103%
Medical Mutual	$41,071	313%

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 $868.
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 Allegheny General 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.