Total hip replacement
Facility: Memorial Hospital
Billing Code: 27130 (CPT)
- CPT Billing Code: 27130
- Insurance Median: $1,111
- Cash Discount Price: $1,399
- vs. Medicare Baseline: 0.08x 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 |
|---|---|---|
| Tricare | $1,058 | 8% |
| Ambetter / Centene | $1,163 | 9% |
Consumer Guidance & Cost Commentary
For a total hip replacement at Memorial Hospital in Abilene, KS, the cash price is $1,399, which matches the facility's median negotiated rate for Tricare and Ambetter/Centene plans. While the facility is a Critical Access Hospital with a government ownership structure, the cash price is significantly lower than the Medicare benchmark of $13,116.76, reflecting a markup of only 10% above the federal baseline. This suggests that paying out-of-pocket may be the most cost-effective option for patients with high-deductible plans, as the insurance negotiated rates do not offer a substantial discount over the cash price. Patients should verify if the hospital offers prompt-pay discounts, which could further reduce the final amount owed by 20% to 50% if settled within 30 days.
It is important to note that this facility is located in Abilene, Kansas, and while specific county average data was not provided in the report, the cash rate of $1,399 serves as a clear baseline for comparison against other local providers. Because the facility is in-network for the listed payers, patients are protected from balance billing for the primary procedure under the No Surprises Act, though they should still review their itemized bill to ensure no out-of-network ancillary services were charged. If you receive a summary bill, request a full itemized statement to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected through a formal written audit. Always confirm your deductible status before scheduling, as paying the full cash price may be preferable if your insurance plan has not yet met its deductible threshold.