CMS Price Transparency Data

Total hip replacement

Facility: Mount Carmel St Ann's

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $25,481
Cash Discount Price: $50,445
vs. Medicare Baseline: 1.94x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Mount Carmel St Ann's is $25,481. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50,445. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.94x the Medicare baseline. Located in 500 South Cleveland Avenue, Westerville, OH.

Cash / Self-Pay

$50,445

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,481

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$13,116.76

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $13,116.76 (100%)

Cash / Self-Pay: $50,445 (385%)

Insurance Median: $25,481 (194%)

Cash: $50,445 (385% of Medicare)

Ins. Median: $25,481 (194% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Crime Victim Assistance	$632	5%
Ohio Safe Program	$632	5%
Aetna	$7,584 - $12,738	58%
Rural Carrier Health Benefit Plan	$7,584	58%
Medicare (plans)	$10,883 - $12,998	83%
Blue Cross Blue Shield	$12,132 - $46,178	92%
UnitedHealthcare	$12,374 - $42,111	94%
Hospice Mount Carmel	$12,379	94%
The Health Plan	$12,627	96%
Oscar	$20,426	156%
Enterprise Group Planning	$23,892	182%
Custom Design Benefits	$25,873	197%
Quality Care Partners	$27,977	213%
Medical Mutual	$30,421 - $44,045	232%
Geha	$42,111	321%
Western & Southern Financial Group	$44,045	336%
Blue Benefit Administrators Of Massachusetts	$46,178	352%
Blue Care Network	$46,178	352%
Blue Distinction Transplant	$46,178	352%
Blue Shield - Ca	$46,178	352%
Blue Shield - Id (Regence)	$46,178	352%
Blue Shield - Ny Highmark Northeastern	$46,178	352%
Blue Shield - Ny Highmark Western	$46,178	352%
Blue Shield - Pa (Highmark)	$46,178	352%
Blue Shield - Wa (Regence)	$46,178	352%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $50,445.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 27130.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mount Carmel St Ann's is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 27130.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.