Total hip replacement
Facility: Community Memorial Healthcare, Inc.
Billing Code: 27130 (CPT)
- CPT Billing Code: 27130
- Insurance Median: $1,389
- Cash Discount Price: $3,330
- vs. Medicare Baseline: 0.11x 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 |
|---|---|---|
| Aetna | $1,058 - $1,615 | 8% |
| UnitedHealthcare | $1,163 | 9% |
| Blue Cross Blue Shield | $2,409 | 18% |
Consumer Guidance & Cost Commentary
For a total hip replacement at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price is $3,330, which matches the facility's median paid amount. This cash rate is significantly lower than the state average for this procedure, making it an attractive option for patients with high-deductible plans or those without insurance. While the facility's negotiated rates with major payers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield range from $1,058 to $2,409, these amounts are often higher than the cash price due to administrative costs and contract structures. Patients should verify their specific plan's deductible status and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by 20% to 50% if paid in full upfront.
It is important to understand that commercial insurance rates are frequently marked up compared to the true cost of care, which is best represented by the Medicare benchmark. For this procedure, the Medicare amount is $13,116.76, yet the facility's cash rate is only about 2.5% of that figure, indicating a substantial difference between federal reimbursement and actual patient pricing. When using insurance, be aware that balance billing can occur if you receive care from out-of-network providers, though the No Surprises Act protects you from such unexpected bills for emergency services at in-network facilities. To ensure you are not overcharged, always request a detailed, itemized bill before signing any consent waivers or making payments, as summary bills often hide errors or unbundled charges that could be disputed.