CMS Price Transparency Data

Total hip replacement

Facility: Valor Health

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $3,386
Cash Discount Price: $21,630
vs. Medicare Baseline: 0.26x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Valor Health is $3,386. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21,630. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.26x the Medicare baseline. Located in 1202 East Locust Street, Emmett, ID.

Cash / Self-Pay

$21,630

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,386

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: $21,630 (165%)

Insurance Median: $3,386 (26%)

Cash: $21,630 (165% of Medicare)

Ins. Median: $3,386 (26% 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	$119 - $35,048	1%
Tricare	$1,007 - $19,136	8%
Blue Cross Blue Shield	$1,060 - $41,134	8%
Blue Shield Mcr Adv	$1,060 - $19,727	8%
Humana	$1,060 - $41,134	8%
Molina Mcr Adv - All Plans	$1,060 - $19,727	8%
Pacificsource Mcr Adv	$1,060 - $20,714	8%
Regence Bs Triwest - All Plans	$1,060 - $19,727	8%
Select Health Mcr Adv	$1,060	8%
UnitedHealthcare	$1,060 - $38,783	8%
Cigna	$2,008 - $38,741	15%
Moda Health - All Plans	$2,119 - $39,874	16%
Select Health Comm - All Other Plans	$2,298 - $39,874	18%
Blue Shield Comm - All Other Plans	$2,575 - $39,874	20%
Pacificsource Comm - All Other Plans	$2,842 - $39,874	22%

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 $21,630.
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 Valor Health 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.