CMS Price Transparency Data

Total knee replacement

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $2,557
Cash Discount Price: $4,030
vs. Medicare Baseline: 0.19x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Iowa Specialty Hospital - Clarion is $2,557. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,030. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.19x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$4,030

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,557

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: $4,030 (31%)

Insurance Median: $2,557 (19%)

Cash: $4,030 (31% of Medicare)

Ins. Median: $2,557 (19% 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
Tricare	$1,046	8%
Triwest Va - All Plans	$1,046	8%
Aetna	$1,280	10%
Healthscope Stellar-All Plans	$1,725	13%
UnitedHealthcare	$2,323	18%
Wellmark Hmo	$2,344	18%
Health Partners Ish-All Other Plans	$2,770	21%
Wellmark Ppo - All Other Plans	$2,780	21%
Cigna	$2,827	22%
Midlands Choice-All Plans	$2,827	22%
Auxiant Clarion Schools-All Plans	$4,365	33%
Health Partners Prestage	$5,037	38%

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 $4,030.
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 Iowa Specialty Hospital - Clarion 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.