CMS Price Transparency Data

Total hip replacement

Facility: Caribou Medical Center

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $2,742
Cash Discount Price: $2,678
vs. Medicare Baseline: 0.21x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Caribou Medical Center is $2,742. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,678. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.21x the Medicare baseline. Located in 300 South 3Rd West, Soda Springs, ID.

Cash / Self-Pay

$2,678

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,742

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: $2,678 (20%)

Insurance Median: $2,742 (21%)

Cash: $2,678 (20% of Medicare)

Ins. Median: $2,742 (21% 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	$158 - $2,742	1%
Humana	$1,060	8%
Pacific Source Mcr Adv	$1,060	8%
Regence Blue Shield Mcr	$1,060	8%
Select Health Mcr Adv	$1,060	8%
Blue Cross Blue Shield	$1,219 - $2,882	9%
Cigna	$1,801	14%
Select Health-All Other Plans	$2,130	16%
Montana Health Co-Op-All Plans	$2,745	21%
Bc Qualified Hp (Qhp)	$2,882	22%
Select Health/Bright Path Mcr Adv	$2,982	23%
Regence Blue Shield-All Other Plans	$3,343	25%
First Choice Health-All Plans	$3,442	26%
Pacific Source-All Other Plans	$3,710	28%
UnitedHealthcare	$3,748	29%

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 $2,678.
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 Caribou 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.