CMS Price Transparency Data

Total hip replacement

Facility: Avita Ontario

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 27130
  • Insurance Median: $13,117
  • Cash Discount Price: $68,594
  • vs. Medicare Baseline: 1.00x Medicare
The contracted insurance negotiated median rate for a Total hip replacement at Avita Ontario is $13,117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68,594. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.00x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.
Cash / Self-Pay
$68,594

Average discount available for prompt cash payment at this facility.

Insurance Median
$13,117

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: $68,594 (523%)
Insurance Median: $13,117 (100%)
Cash: $68,594 (523% of Medicare)
Ins. Median: $13,117 (100% 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.

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
Blue Cross Blue Shield $2,122 - $57,538 16%
Buckeye $2,122 - $13,117 16%
Caresource $2,122 16%
Humana $2,122 - $13,117 16%
Medicaid / KanCare $2,122 16%
Molina $2,122 - $13,117 16%
United_Healthcare $2,122 - $58,304 16%
Amerihealth $2,638 20%
Aetna $13,117 - $80,698 100%
Medical_Mutual $13,117 - $64,559 100%
Medicare (plans) $13,117 100%
Mount_Carmel $13,117 100%
Cigna $62,864 479%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 715 Richland Mall, Ontario, OH 44906
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals