CMS Price Transparency Data

Total hip replacement

Facility: Pacifica Hospital of the Valley

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $12,198
Cash Discount Price: $5,646
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Pacifica Hospital of the Valley is $12,198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,646. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.93x the Medicare baseline. Located in 9449 San Fernando Rd, Sun Valley, CA.

Cash / Self-Pay

$5,646

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,198

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: $5,646 (43%)

Insurance Median: $12,198 (93%)

Cash: $5,646 (43% of Medicare)

Ins. Median: $12,198 (93% 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	$2,823	22%
Altamed	$5,646	43%
Blue Cross Blue Shield	$5,646 - $12,198	43%
Heritage Provider Network	$5,646	43%
Molina	$5,646	43%
Alignment Health	$9,758	74%
America Cash Health Plan	$12,198	93%
Care 1St Health Plan	$12,198	93%
Humana	$12,198	93%
La Health Care	$12,198	93%
Bright Health Group	$12,808	98%
Health Net Of California	$15,247	116%

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 $5,646.
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 Pacifica Hospital of the Valley 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.