Total hip replacement
Facility: Pratt Regional Medical Center
Billing Code: 27130 (CPT)
- CPT Billing Code: 27130
- Insurance Median: $2,719
- Cash Discount Price: $1,882
- vs. Medicare Baseline: 0.21x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Christian Health Aid | $683 - $2,719 | 5% |
| UnitedHealthcare | $757 - $13,418 | 6% |
| Health Partners Of Kansas | $774 - $3,081 | 6% |
| Aetna | $819 - $3,263 | 6% |
| Choicecare | $910 - $3,625 | 7% |
| Celtic Insurance Company | $12,198 | 93% |
| Healthy Blue | $12,564 | 96% |
Consumer Guidance & Cost Commentary
For a total hip replacement at Pratt Regional Medical Center in Pratt, KS, the facility's cash median rate of $1,882 is significantly lower than the negotiated rates charged by major insurers like UnitedHealthcare, which can reach up to $13,418. While the facility's negotiated rate of $2,719 is the highest among the seven payers listed, it remains below the gross chargemaster price of $2,689. Patients with high-deductible plans or those without insurance may find the cash price most advantageous, as it avoids the administrative overhead and markup inherent in insurance billing cycles. It is important to note that while the facility is a Proprietary Acute Care Hospital, commercial rates often exceed the true cost baseline represented by Medicare, which is $13,116.76 for this procedure; however, the cash rate is notably lower than the Medicare amount, highlighting the potential savings for self-pay patients.
To minimize unexpected costs, consumers should actively request a prompt-pay discount or self-pay rate before scheduling, as these upfront payments can bypass the costly insurance claims process and reduce the total bill by 20% to 50%. If a patient receives a bill after using insurance, they should verify that the facility is in-network and that no balance billing is occurring, as the No Surprises Act protects against out-of-network charges for emergency care and services at in-network facilities. Furthermore, patients should demand a full itemized CPT-coded bill rather than accepting a summary invoice, as detailed statements allow for the identification of errors, unbundled codes, or services not rendered, which are common sources of medical debt. Given that over 80%