CMS Price Transparency Data

Total hip replacement

Facility: Canyon Vista Medical Center

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $17,461
Cash Discount Price: $20,086
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Canyon Vista Medical Center is $17,461. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20,086. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.33x the Medicare baseline. Located in 5700 East Highway 90, Sierra Vista, AZ.

Cash / Self-Pay

$20,086

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,461

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: $20,086 (153%)

Insurance Median: $17,461 (133%)

Cash: $20,086 (153% of Medicare)

Ins. Median: $17,461 (133% 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
University Phyicians Inc	$11,852	90%
UnitedHealthcare	$15,128 - $53,471	115%
Humana	$15,422	118%
Ambetter / Centene	$17,461	133%
Government Employees Health Association	$21,459	164%
Blue Cross Blue Shield	$31,866	243%

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 $20,086.
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 Canyon Vista 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.