CMS Price Transparency Data

Total knee replacement

Facility: Santa Clara Valley Medical Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $1,786
Cash Discount Price: $11,210
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Santa Clara Valley Medical Center is $1,786. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11,210. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.14x the Medicare baseline. Located in 751 South Bascom Avenue, San Jose, CA.

Cash / Self-Pay

$11,210

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,786

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: $11,210 (85%)

Insurance Median: $1,786 (14%)

Cash: $11,210 (85% of Medicare)

Ins. Median: $1,786 (14% 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
Healthnet	$1,488	11%
Onlok	$1,488	11%
Santa Clara Family Health Plan	$1,488 - $3,076	11%
Aetna	$1,776	14%
UnitedHealthcare	$1,786	14%
Cigna	$2,017 - $3,335	15%
Phcs-Multiplan	$2,158	16%
Blue Cross Blue Shield	$3,000 - $12,745	23%

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 $11,210.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 27447.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Santa Clara Valley Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 27447.
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.