CMS Price Transparency Data

Total hip replacement

Facility: Mercyone Dubuque Medical Center

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $9
Cash Discount Price: $42,385
vs. Medicare Baseline: 0.00x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Mercyone Dubuque Medical Center is $9. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42,385. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.00x the Medicare baseline. Located in 250 Mercy Drive, Dubuque, IA.

Cash / Self-Pay

$42,385

Average discount available for prompt cash payment at this facility.

Insurance Median

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: $42,385 (323%)

Insurance Median: $9 (0%)

Cash: $42,385 (323% of Medicare)

Ins. Median: $9 (0% 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
Iowa Total Care	$11,518	88%
Medicaid / KanCare	$11,631 - $11,676	89%
Aetna	$12,507	95%
Medicare (plans)	$12,507 - $13,018	95%
Blue Cross Blue Shield	$12,632	96%
UnitedHealthcare	$12,758	97%
Amish Hospital Aid	$16,974	129%
Oscar	$17,411	133%
Centivo	$19,986	152%
Ambetter / Centene	$21,441	163%
Claimdoc	$25,653	196%
Nova	$25,653	196%

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 $42,385.
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 Mercyone Dubuque Medical Center 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.