CMS Price Transparency Data

Total hip replacement

Facility: Fayette County Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,322
Cash Discount Price: $5,861
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Fayette County Hospital is $1,322. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,861. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.10x the Medicare baseline. Located in 650 W Taylor St, Vandalia, IL.

Cash / Self-Pay

$5,861

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,322

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: $5,861 (45%)

Insurance Median: $1,322 (10%)

Cash: $5,861 (45% of Medicare)

Ins. Median: $1,322 (10% 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	$950 - $1,686	7%
Blue Cross Blue Shield	$950 - $2,837	7%
Illinicare - All Plans	$950	7%
Medicaid / KanCare	$950	7%
Meridian-All Plans	$950	7%
Health Alliance Mcare	$1,204	9%
Healthlink Mcr Adv	$1,204	9%
Cigna	$1,440	11%
Coventry/Ghp-All Plans	$1,686	13%
Multiplan - All Plans	$2,228	17%
Health Alliance - All Other Plans	$2,409	18%
UnitedHealthcare	$4,864	37%
Healthlink Hmo	$5,040	38%
Healthlink Ppo - All Other Plans	$5,040	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 $5,861.
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 Fayette County 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.