CMS Price Transparency Data

Total hip replacement

Facility: Carle Eureka Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $3,191
Cash Discount Price: $7,090
vs. Medicare Baseline: 0.24x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Carle Eureka Hospital is $3,191. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,090. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.24x the Medicare baseline. Located in 101 S Major St, Eureka, IL.

Cash / Self-Pay

$7,090

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,191

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: $7,090 (54%)

Insurance Median: $3,191 (24%)

Cash: $7,090 (54% of Medicare)

Ins. Median: $3,191 (24% 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
Meridian	$709 - $3,403	5%
Humana	$1,204 - $3,190	9%
Aetna	$1,240 - $4,686	9%
Molina	$1,418 - $3,403	11%
UnitedHealthcare	$3,190 - $4,375	24%
Community Partners Health Plan (Cphp)	$4,254	32%
Healthlink	$4,608	35%
Blue Cross Blue Shield	$4,750 - $5,956	36%
Multiplan/Phcs	$5,318	41%
Wellcare	$13,758	105%

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 $7,090.
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 Carle Eureka 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.