A CPT (Current Procedural Terminology) code is a five-digit numerical code used by medical professionals to report medical, surgical, and diagnostic procedures and services. These codes provide a uniform language for describing medical services for billing and record-keeping purposes among physicians, health insurance companies, and other healthcare entities.

How can I find the cost of a specific medical procedure or service?

The cost of medical procedures and services can vary significantly based on your location, healthcare provider, facility type, and insurance plan. To get an estimate for a specific CPT code or service in your area, you can use Payerprice. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and your specific location to find relevant pricing information.

Why do medical costs vary so much?

Medical costs vary due to a multitude of factors, including geographic location, the specific healthcare provider or facility, negotiations between providers and insurance companies, the complexity of the procedure, and whether the service is delivered in-network or out-of-network. Supply and demand, technology utilization, and administrative costs also play a role in cost discrepancies.

How can I estimate my out-of-pocket costs for a medical procedure?

To estimate your out-of-pocket costs, you need to consider your insurance plan's deductible, copayments, and coinsurance, as well as the provider's charges. First, identify the CPT code for the service you need. Then, you can use a tool like Payerprice to look up the typical fees for that CPT code in your specific location. Once you have an estimated cost, apply your insurance benefits to calculate your potential financial responsibility. It's always best to confirm with both your insurance provider and the healthcare facility for the most accurate estimate.

CPT 27130 Fee Schedule

Q: What factors affect fee schedules?

Factors that affect fee schedules include Medicare & Medicaid Rates (government-set reimbursement amounts), Private Insurance Rates (negotiated rates between providers and insurance companies), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital providers may have different rates than private practice).

Last Verified: October 2026

Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.

Surgical Service Bundle Includes All Surgery Related Health Services Which Are Incurred In Connection With An Approved Outpatient Surgical Procedure, Billed Via The Agreed Upon Cpt Codes And Reimbursed At A Single Payment Rate Including All Services Such

Key Fact	Detail
Service Type	Surgery Surgical Procedures on the Musculoskeletal System
Common Place of Service	22 - On Campus Outpatient Hospital 24 - Ambulatory Surgical Center
Common Modifiers	None RT - Right side of body LT - Left side of body
Complexity Level	High
Medicare Fee Schedule	View Medicare rates for 27130
Medicaid Fee Schedule	View Medicaid rates for 27130

National average reimbursement for CPT 27130 by major payers:

$1,758.30

$1,871.72

$1,961.59

$2,181.73

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CPT 27130

5 of 25 sample ratesHigher to lower in this preview

Alexander Volvovsky
Summit Medical Group, P.A.
NYDiagnostic Radiology PhysicianNPI 1013100098Tax ID 22-3487984
$4,774.64Published rate
Lea Thies
Inova Health Care Services
VAFamily Nurse PractitionerNPI 1710266804Tax ID 54-0620889
$3,143.72Published rate
Resham Khan
Atlantic Health System Inc
NJStudent in an Organized Health Care Education/Training ProgramNPI 1982212015Tax ID 20-2088165
$2,471.11Published rate
Samuel Bone
Summit Medical Group, P.A.
MNDiagnostic Radiology PhysicianNPI 1841216306Tax ID 22-3487984
$2,268.08Published rate
Plinio Caldera
Uvalde Medical And Surgical Associates
TXOrthopaedic Surgery PhysicianNPI 1982668695Tax ID 26-3639152
$1,373.30Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

This code appears in 1 published specialty market.

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CPT 27130 vs. Other Surgical Procedures on the Musculoskeletal System Codes

The CPT 27130 code is part of the Surgery services used for Surgical Procedures on the Musculoskeletal System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 27130 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
27120-CPT	High	Surgical Repair Of Hip Socket, Surgery To Restore Socket Of Hip Joint (Acetabulum) To Its Normal State. Any Damaged Or Infected Bone Or Material Is Removed. A Cast Is Applied.
27125-CPT	High	Hemiarthroplas Hip Partial (Eg Fmoral Stem Prosthes Bipolar, Hemiarthroplasty Hip Partial (Eg Femoral Stem Prosthesis Bipolar A
27130-CPT	High	Surgical Service Bundle Includes All Surgery Related Health Services Which Are Incurred In Connection With An Approved Outpatient Surgical Procedure, Billed Via The Agreed Upon Cpt Codes And Reimbursed At A Single Payment Rate Including All Services Such
27132-CPT	High	Conversion Of Previous Hip Sur, Conversion Of Previous Hip Surgery To Total Hip Replacementwith Or Without Autograft Or Allograft

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 27130. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 27130 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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CPT 27130 Fee Schedule

Compare published rates across providers.

Alexander Volvovsky

Lea Thies

Resham Khan

Samuel Bone

Plinio Caldera