Total hip replacement
Facility: Holton Community Hospital
Billing Code: 27130 (CPT)
- CPT Billing Code: 27130
- Insurance Median: $14,769
- Cash Discount Price: $11,648
- vs. Medicare Baseline: 1.13x 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 |
|---|---|---|
| UnitedHealthcare | $1,058 - $27,590 | 8% |
| Aetna | $1,058 - $27,590 | 8% |
| Humana | $1,068 - $14,769 | 8% |
| Kansas Superior Select - All Plans | $1,079 - $14,915 | 8% |
| Medicaid / KanCare | $1,113 - $27,590 | 8% |
| Preferred Health Fn Select - All Other Plans | $22,900 | 175% |
| Preferred Health Professionals | $22,900 | 175% |
| Preferred Health Freedom | $22,900 | 175% |
| Wppa Providers - All Plans | $26,210 | 200% |
Consumer Guidance & Cost Commentary
For a total hip replacement at Holton Community Hospital in Holton, Kansas, the facility's cash price of $11,648 is lower than the median negotiated rate of $14,769 paid by insurance carriers. While the gross charge listed is $15,530, patients with high-deductible plans may find paying out-of-pocket initially more cost-effective if their insurance negotiated rate exceeds the cash price, as commercial contracts often include administrative overhead that inflates the baseline price. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the specific negotiated rates vary significantly across payers, ranging from $1,058 for UnitedHealthcare and Aetna up to $22,900 for Preferred Health Professionals, meaning the actual amount you owe depends entirely on your specific plan and deductible status.
The facility's cash price of $11,648 is also notably lower than the Medicare benchmark amount of $13,116.76, which serves as a scientifically validated baseline for the true cost of care delivery. Although the data does not provide explicit state or county average comparisons for this specific procedure, the significant gap between the cash price and the Medicare rate highlights the potential for substantial savings when paying directly. To maximize these savings, patients should request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often offer fee reductions of 20% to 50% for upfront payment that bypasses costly insurance claims processing. Additionally, since over 80% of hospital bills contain errors, you should request a full itemized CPT-coded statement to audit for unbundled