Total hip replacement
Facility: Regional Medical Center
Billing Code: 27130 (CPT)
- CPT Billing Code: 27130
- Insurance Median: $870
- Cash Discount Price: $13,386
- vs. Medicare Baseline: 0.07x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 7% |
Consumer Guidance & Cost Commentary
The cash price for a Total hip replacement at Regional Medical Center in Manchester, IA is $13,386, which is significantly lower than the facility's gross charge of $16,732 and the Medicare benchmark of $13,116.76. While the facility is a Critical Access Hospital with a government-local ownership structure, the cash rate remains a key reference point for patients, particularly when compared to the state of Iowa and the broader region where insurance negotiated rates often exceed out-of-pocket cash options.
For patients with high-deductible plans, paying the cash price of $13,386 upfront may be more cost-effective than relying on the insurance negotiated rate of $870, which reflects the contract with Medical Associates Health Plan - Tri. Although the facility offers a prompt-pay discount mechanism that could further reduce the bill, it is essential to request self-pay classification before check-in to avoid automatic claims submission that would void the cash agreement. Consumers should also verify their deductible status to ensure they are not inadvertently paying the full negotiated rate without realizing they have not yet met their plan's coverage threshold.