CMS Price Transparency Data

Total hip replacement

Facility: St Luke's McCall

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $14,300
Cash Discount Price: $15,889
vs. Medicare Baseline: 1.09x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at St Luke's McCall is $14,300. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $15,889. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.09x the Medicare baseline. Located in 1000 State Street, McCall, ID.

Cash / Self-Pay

$15,889

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,300

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: $15,889 (121%)

Insurance Median: $14,300 (109%)

Cash: $15,889 (121% of Medicare)

Ins. Median: $14,300 (109% 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
Commercial [1028]	$9,216 - $15,253	70%
Medicare (plans)	$9,216 - $9,400	70%
Veterans Affairs [1056]	$9,216	70%
Blue Cross Blue Shield	$9,308 - $13,982	71%
Aetna	$10,137 - $15,095	77%
Moda [1055]	$13,982	107%
Cigna	$14,777	113%
Providence [1022]	$14,777	113%
Pacificsource [1020]	$14,936	114%
First Health [1064]	$15,095	115%
Webtpa [1071]	$15,095	115%
Geha [1065]	$15,253	116%
United Medical Resources [1051]	$15,253	116%
UnitedHealthcare	$15,253	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 $15,889.
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 St Luke's McCall 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.