CMS Price Transparency Data

Total hip replacement

Facility: Memorial Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $4,952
Cash Discount Price: $14,147
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Memorial Hospital is $4,952. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,147. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.38x the Medicare baseline. Located in 1454 N County Road 2050 E, Carthage, IL.

Cash / Self-Pay

$14,147

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,952

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: $14,147 (108%)

Insurance Median: $4,952 (38%)

Cash: $14,147 (108% of Medicare)

Ins. Median: $4,952 (38% 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
Aetna	$4,952	38%
Blue Cross Blue Shield	$4,952	38%
Cigna	$4,952	38%
Health Alliance	$4,952	38%
Humana	$4,952	38%
Meridian	$4,952	38%
Molina	$4,952	38%
UnitedHealthcare	$4,952	38%

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 $14,147.
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 Memorial 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.