CMS Price Transparency Data

Total knee replacement

Facility: Midstate Medical Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $5,247
Cash Discount Price: $7,390
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Midstate Medical Center is $5,247. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,390. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.40x the Medicare baseline. Located in 435 Lewis Avenue, Meriden, CT.

Cash / Self-Pay

$7,390

Average discount available for prompt cash payment at this facility.

Insurance Median

$5,247

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: $7,390 (56%)

Insurance Median: $5,247 (40%)

Cash: $7,390 (56% of Medicare)

Ins. Median: $5,247 (40% 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
Oxford	$2,036	16%
United	$2,036 - $5,247	16%
Health New England	$2,702 - $5,247	21%
Cigna	$3,023 - $25,800	23%
Connecticare	$3,337 - $4,170	25%
Blue Cross Blue Shield	$3,496 - $35,000	27%
Aetna	$4,128 - $28,000	31%
Molina Dba Connecticare	$5,247 - $37,843	40%
Tufts	$5,247	40%
Wellcare	$5,352	41%

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 $7,390.
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 Midstate 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.