Total hip replacement
Facility: Providence Medical Center
Billing Code: 27130 (CPT)
- CPT Billing Code: 27130
- Insurance Median: $14,010
- Cash Discount Price: $12,095
- vs. Medicare Baseline: 1.07x 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 |
|---|---|---|
| Comp Alliance - Fka Compresults Worker Compensation | $2,699 | 21% |
| Aetna | $5,440 - $12,095 | 41% |
| UnitedHealthcare | $8,509 - $16,934 | 65% |
| Medicaid / KanCare | $8,509 | 65% |
| Healthy Blue | $8,679 - $12,700 | 66% |
| Celtic | $8,679 - $19,353 | 66% |
| Midland Care Connection | $12,095 | 92% |
| Tricare | $12,095 | 92% |
| Cigna | $12,095 | 92% |
| Medicare (plans) | $12,095 | 92% |
| Kansas Superior Select | $12,700 | 97% |
| Employer Direct Healthcare | $15,320 - $16,934 | 117% |
| Corizon | $15,320 - $15,724 | 117% |
| Well Path Prison | $15,320 - $16,934 | 117% |
| Centurion | $15,320 - $18,143 | 117% |
| Blue Cross Blue Shield | $15,320 - $22,377 | 117% |
| Naphcare | $15,320 - $18,748 | 117% |
Consumer Guidance & Cost Commentary
For a total hip replacement at Providence Medical Center in Kansas City, KS, the cash price is $12,095, which is lower than the facility's gross charge of $45,189. While many insurance plans negotiate rates ranging from $8,509 to $22,377, the cash rate remains the most predictable option for patients without insurance or those with high-deductible plans. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures; in this case, the median negotiated rate is $14,010, which is higher than the cash price. Patients should verify their specific plan's allowed amount before scheduling, as some in-network contracts may result in higher out-of-pocket costs than paying self-pay. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final balance if paid in full upfront.
This procedure is benchmarked against Medicare, which sets a fixed reimbursement rate of $13,116.76 for this service. The facility's cash rate of $12,095 is approximately 92% of the Medicare amount, indicating a pricing structure that is below the federal baseline. While the facility is a voluntary non-profit church-owned acute care hospital with a rating of 3, the primary financial consideration for consumers is the difference between the cash price and their insurance coverage. If a patient's insurance allows a higher amount than the cash price, paying out-of-pocket might still be the most cost-effective strategy. To avoid unexpected costs, patients should request an itemized bill to review specific CPT codes and ensure no unb