CMS Price Transparency Data

Total hip replacement

Facility: St Anthony Regional Hospital & Nursing Home

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 27130
  • Insurance Median: $1,665
  • Cash Discount Price: $3,674
  • vs. Medicare Baseline: 0.13x Medicare
The contracted insurance negotiated median rate for a Total hip replacement at St Anthony Regional Hospital & Nursing Home is $1,665. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,674. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.13x the Medicare baseline. Located in 311 South Clark Street, Carroll, IA.
Cash / Self-Pay
$3,674

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,665

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: $3,674 (28%)
Insurance Median: $1,665 (13%)
Cash: $3,674 (28% of Medicare)
Ins. Median: $1,665 (13% 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.

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
Aetna $1,047 - $2,562 8%
Humana $1,047 - $3,123 8%
Medica Mcr - All Plans $1,047 8%
UnitedHealthcare $1,047 - $1,676 8%
Va Ccn - All Plans $1,047 8%
Wellpoint Mcr Adv $1,047 8%
Ia Total Care Mcr $1,079 8%
Ia Total Care Comm - All Other Plans $1,362 10%
Wellmark Hmo $2,498 19%
Wellmark Ppo-All Other Plans $2,939 22%
Ia Total Care Mcaid $3,674 28%
Wellpoint Mcaid - All Other Plans $3,674 28%
Molina Mcaid - All Plans $3,747 29%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 311 South Clark Street, Carroll, IA 51401
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals