CMS Price Transparency Data

Total knee replacement

Facility: Madison County Health Care System

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $2,923
Cash Discount Price: $2,725
vs. Medicare Baseline: 0.22x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Madison County Health Care System is $2,923. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,725. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.22x the Medicare baseline. Located in 300 West Hutchings Street, Winterset, IA.

Cash / Self-Pay

$2,725

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,923

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: $2,725 (21%)

Insurance Median: $2,923 (22%)

Cash: $2,725 (21% of Medicare)

Ins. Median: $2,923 (22% 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
Aetna	$1,046	8%
Choicecare-All Plans	$1,046	8%
Medical Associates Hp - All Plans	$1,046	8%
Medigold-All Plans	$1,046	8%
Medimore Employee Hp - All Plans	$1,046	8%
Tricare	$1,046	8%
UnitedHealthcare	$1,046 - $3,406	8%
American Hp Mcr Adv-All Plans	$1,098	8%
Madison County Sheriff-All Plans	$1,703	13%
Oscar - All Plans	$1,809	14%
Blue Cross Blue Shield	$2,344 - $2,780	18%
Midlands Choice - All Plans	$2,729	21%
Corvel Wc-All Plans	$3,065	23%
First Choice-All Plans	$3,236	25%
First Health-All Plans	$3,236	25%
Integrated Hp-All Plans	$3,236	25%
Mutual Of Omaha-All Plans	$3,236	25%
Plaines Health-All Plans	$3,236	25%
Preferred Hlth Ntwork-All Plans	$3,236	25%
Principal Healthcare-All Plans	$3,236	25%
Usa Managed Care-All Plans	$3,236	25%
Benefit Admin Of America-All Plans	$3,406	26%
Iowa Total Care Mcaid-All Plans	$3,406	26%
Molina Mcaid/Chip -All Plans	$3,491	27%
Amerigroup Mcaid-All Plans	$3,610	28%

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 $2,725.
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 Madison County Health Care System 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.