CMS Price Transparency Data

Total knee replacement

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $2,024
Cash Discount Price: $4,587
vs. Medicare Baseline: 0.15x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Cleveland Clinic Indian River Hospital is $2,024. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,587. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.15x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$4,587

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,024

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: $4,587 (35%)

Insurance Median: $2,024 (15%)

Cash: $4,587 (35% of Medicare)

Ins. Median: $2,024 (15% 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
UnitedHealthcare	$943	7%
Amerihealth	$993	8%
Medicaid / KanCare	$993	8%
Molina	$993	8%
Value Options	$993 - $1,356	8%
Wellcare	$993 - $12,915	8%
Avmed	$1,356 - $29,576	10%
Blue Cross Blue Shield	$1,356 - $12,915	10%
Careplus	$1,356 - $12,915	10%
Magellan	$1,356	10%
United	$1,356 - $12,915	10%
Freedom Health	$1,424 - $12,915	11%
Independent Living Systems	$1,424 - $13,561	11%
Wellmed	$1,424 - $12,915	11%
Clear Spring Health	$1,464	11%
Aetna	$1,517 - $12,915	12%
Cigna	$1,902 - $2,439	15%
Clarity Health	$4,587	35%
The Legacy Companies	$4,587	35%
National Provider Network	$4,940	38%
Three Rivers	$4,940	38%
Consociate Health	$5,293	40%
Carelon Bh Strategies	$12,915	98%
Humana	$12,915	98%
Devoted Health	$14,207	108%

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 $4,587.
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 Cleveland Clinic Indian River Hospital 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.