CMS Price Transparency Data

Total hip replacement

Facility: Porter Hospital Inc

Billing Code: 27130 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27130
Insurance Median: $1,217
Cash Discount Price: $3,234
vs. Medicare Baseline: 0.09x Medicare

The contracted insurance negotiated median rate for a Total hip replacement at Porter Hospital Inc is $1,217. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,234. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.09x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.

Cash / Self-Pay

$3,234

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,217

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: $3,234 (25%)

Insurance Median: $1,217 (9%)

Cash: $3,234 (25% of Medicare)

Ins. Median: $1,217 (9% 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
Wellpath	$356 - $1,779	3%
Coventry	$421 - $1,552	3%
Blue Cross Blue Shield	$500 - $28,684	4%
Medical Corporation	$615 - $3,072	5%
Multiplan	$615 - $3,072	5%
Veterans Affairs Community Care Network	$647 - $1,194	5%
UnitedHealthcare	$840 - $2,713	6%
Mvp	$1,015 - $2,494	8%
Fidelis Care	$1,074	8%
Humana	$1,134 - $12,223	9%
Aetna	$1,194	9%
Martins Point	$1,194	9%
Veterans Choice	$1,194	9%
Capital District Physicians' Health Plan	$1,199 - $1,952	9%
Harvard Pilgrim	$1,442	11%
Cigna	$2,324	18%

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 $3,234.
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 Porter Hospital Inc 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.