CMS Price Transparency Data

Total hip replacement

Facility: Independence Health System Butler Memorial Hospita

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $13,245
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Independence Health System Butler Memorial Hospita is $13,245. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.01x the Medicare baseline. Located in One Hospital Way, Butler, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,245

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%)

Insurance Median: $13,245 (101%)

Ins. Median: $13,245 (101% 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
Aetna	$3,339 - $28,470	25%
Pnoa	$5,092 - $13,616	39%
Highmark	$12,131 - $26,110	92%
Life Butler County	$12,378	94%
Martin'S Point - Usfhp	$12,378	94%
Medicare (plans)	$12,378	94%
Peak Health	$12,378 - $29,089	94%
Provider Partners	$12,378	94%
Tricare	$12,378	94%
UnitedHealthcare	$12,378 - $31,745	94%
Workers Comp	$12,809	98%
Humana	$12,873	98%
Amerihealth	$12,997	99%
Geisinger	$12,997	99%
Devoted Health Plan	$13,121	100%
The Health Plan	$13,121 - $29,089	100%
Pa Health & Wellness	$13,245	101%
American Health Plan	$13,616	104%
Gateway	$13,896	106%
Highmark Aca - Direct Blue	$16,316	124%
Upmc	$17,453	133%
Ellwood Group	$24,756	189%
Highmark Community Blue	$25,598	195%
Cigna	$28,282	216%
Highmark - Ind.& Managed Care	$29,012	221%

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 $X.
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 Independence Health System Butler Memorial Hospita 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.