CMS Price Transparency Data

Total hip replacement

Facility: Mon Health Medical Center

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $2,656
Cash Discount Price: $1,369
vs. Medicare Baseline: 0.20x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Mon Health Medical Center is $2,656. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,369. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.20x the Medicare baseline. Located in 1200 Jd Anderson Drive, Morgantown, WV.

Cash / Self-Pay

$1,369

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,656

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: $1,369 (10%)

Insurance Median: $2,656 (20%)

Cash: $1,369 (10% of Medicare)

Ins. Median: $2,656 (20% 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
Maryland_Physicians_Care_Plan	$1,916	15%
Aetna	$2,190 - $12,419	17%
The_Health_Plan_Murray_Energy_Commercial_Aso_Plan	$2,190	17%
The_Health_Plan_Plan	$2,355	18%
Acpn_Plan	$2,464	19%
Cigna	$2,464	19%
Humana	$2,464 - $12,419	19%
Mon_County_Commission_Plan	$2,464	19%
Uhc_Plan	$2,464	19%
Health_Payors_Organization_Plan	$2,519	19%
Uhc_Options_Ppo_Plan	$2,546	19%
Multiplan_Phcs_Plan	$2,601	20%
Mutual_Of_Omaha_Plan	$2,601	20%
Geha_Plan	$2,656	20%
Three_Rivers_Plan	$2,656	20%
Uhc_Onenet_Ppo_Plan	$2,656	20%
Upmc__Plan	$2,656	20%
Zelis_Other_Plan	$10,556	80%
The_Health_Plan_Peia_Plan	$12,304	94%
Blue Cross Blue Shield	$12,419 - $61,133	95%
Health_South_Mountain_View_Plan	$12,419	95%
Medicare (plans)	$12,419	95%
Paramount_Elite_Plan	$12,419	95%
Uhc_Va_Plan	$12,419	95%
Zelis_Group_Health_Plan	$12,419	95%
Seven_Corners_Plan	$24,837	189%

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 $1,369.
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 Mon Health Medical Center 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.