CMS Price Transparency Data

Total hip replacement

Facility: Penn State Health St. Joseph

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $14,886
Cash Discount Price: $21,753
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Penn State Health St. Joseph is $14,886. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,753. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.13x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$21,753

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,886

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: $21,753 (166%)

Insurance Median: $14,886 (113%)

Cash: $21,753 (166% of Medicare)

Ins. Median: $14,886 (113% 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
[Amerihealth Caritas]	$11,099 - $13,058	85%
[Highmark Wholecare]	$11,099 - $13,058	85%
[Geisinger]	$11,752 - $60,334	90%
[Health Partners Plans]	$12,144 - $13,319	93%
[Pa Health & Wellness]	$12,209 - $13,449	93%
[Highmark]	$12,927 - $70,970	99%
UnitedHealthcare	$13,058 - $56,620	100%
[Cbc]	$13,058 - $44,209	100%
[Ibc]	$13,058 - $41,566	100%
Aetna	$13,188 - $42,717	101%
Humana	$13,188	101%
[Healthspring]	$13,188	101%
[Upmc]	$13,319 - $61,789	102%
[Point Comfort Underwriters]	$16,322	124%
Cigna	$51,309	391%
[Highmark Choice Blue]	$56,776	433%
[Highmark Aca]	$59,615	454%
[Preferred Healthcare Systems]	$62,726	478%
[First Health]	$66,907	510%
[Multiplan]	$66,907	510%

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 $21,753.
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 Penn State Health St. Joseph 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.