Total hip replacement
Facility: Hiawatha Community Hospital
Billing Code: 27130 (CPT)
- CPT Billing Code: 27130
- Insurance Median: $1,625
- Cash Discount Price: $2,209
- vs. Medicare Baseline: 0.12x 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 - $1,722 | 8% |
| Aetna | $1,058 - $1,663 | 8% |
| Humana | $1,058 | 8% |
| Ambetter / Centene | $1,096 | 8% |
| Centrus Health Direct - All Plans | $1,269 | 10% |
| Healthy Blue Mcaid - All Plans | $1,325 - $3,669 | 10% |
| Wppa Providrs Care - All Plans | $1,493 | 11% |
| Multiplan - All Plans | $1,586 | 12% |
| Oscar - All Plans | $1,692 | 13% |
| Preferred Hlth - All Plans | $1,752 | 13% |
| Cigna | $2,564 | 20% |
| Midlands Choice - All Plans | $2,995 | 23% |
Consumer Guidance & Cost Commentary
For the Total hip replacement procedure at Hiawatha Community Hospital in Hiawatha, KS, the cash price is $2,209. This amount is significantly higher than the state average for this service, which is $1,625. While commercial insurance plans like UnitedHealthcare and Aetna negotiate rates ranging from $1,058 to $1,722, these negotiated amounts often exceed the cash price for patients with high-deductible plans. Because commercial rates include administrative overhead and contract premiums, paying cash directly can sometimes result in lower out-of-pocket costs compared to using insurance, provided the patient has not yet met their deductible.
To minimize costs, patients should verify the facility's "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, since Medicare sets a benchmark of $13,116.76 for this procedure, the hospital's cash rate of $2,209 represents a substantial discount relative to federal standards, though it remains above the state average. Consumers are advised to request an itemized bill to ensure no errors exist and to confirm that any negotiated rates align with the facility's contract terms before finalizing payment.