CMS Price Transparency Data

Total hip replacement

Facility: Dunes Surgical Hospital

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $13,430
Cash Discount Price: $20,145
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Dunes Surgical Hospital is $13,430. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20,145. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.02x the Medicare baseline. Located in 600 N Sioux Point Road, Dakota Dunes, SD.

Cash / Self-Pay

$20,145

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,430

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: $20,145 (154%)

Insurance Median: $13,430 (102%)

Cash: $20,145 (154% of Medicare)

Ins. Median: $13,430 (102% 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
Cigna	$10,062	77%
Midlands Choice	$10,062	77%
Avera Health Plans	$10,781	82%
Multiplan	$10,781	82%
UnitedHealthcare	$11,500 - $13,430	88%
Accountable Healthplan	$12,219	93%
Sanford Health Plan	$12,219	93%
Ne Total Care	$13,430	102%
Siouxland Pace	$13,430	102%
Ia Total Care	$13,699	104%
Wellpoint	$13,699	104%
Molina	$13,833	105%
Amerigroup	$13,887	106%
Health Partners	$13,944	106%
Blue Cross Blue Shield	$14,672	112%
Oscar	$15,982	122%

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 $20,145.
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 Dunes Surgical Hospital 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.