CMS Price Transparency Data

Total knee replacement

Facility: Mt Sinai Hospital Medical Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $13,345
Cash Discount Price: $2,560
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Mt Sinai Hospital Medical Center is $13,345. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,560. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.02x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.

Cash / Self-Pay

$2,560

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,345

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: $2,560 (20%)

Insurance Median: $13,345 (102%)

Cash: $2,560 (20% of Medicare)

Ins. Median: $13,345 (102% 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
Partners In Hlth - All Plans	$1,463	11%
Blue Cross Blue Shield	$1,635 - $13,819	12%
Compsych Ip/Op Only - All Plans	$2,195	17%
Healthlink Hmo	$2,377	18%
Hfn Platinum	$2,377	18%
Healthlink Ppo - All Other Plans	$2,560	20%
Multiplan Primary Ntwrk/Phcs - All Other Plans	$2,560	20%
Hfn Epo	$2,926	22%
Multiplan Complementary Ntwrk	$2,926	22%
Hfn Ppo - All Other Plans	$3,219	25%
Ambetter / Centene	$3,841 - $15,134	29%
Oscar - All Plans	$4,023	31%
Cigna	$4,521 - $14,510	34%
Aetna	$8,266 - $13,819	63%
Humana	$11,485 - $13,758	88%
Tricare	$13,345	102%
Va Healthnet - All Plans	$13,345	102%
Advocate Physician Prtnrs Mcr	$13,758	105%
Cenpatico Illinicare Dual	$13,758	105%
Cenpatico Illinicare Mcr - All Other Plans	$13,758	105%
Lawndale Christian - All Plans	$13,758	105%
Meridian/Harmony D-Snp - All Plans	$13,758	105%
Nextlevel Hlth Icp Fhp Aca - All Plans	$13,758	105%
Family Health Network Mcaid - All Plans	$13,819	105%
Harmony Behavioral Htlh - All Plans	$14,171	108%
Zing Mcr Adv - All Plans	$14,309	109%
Molina Mcr - All Other Plans	$14,446	110%
Molina Mcaid	$14,510	111%
Advocate Physician Prtnrs - All Other Plans	$15,134	115%

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 $2,560.
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 Mt Sinai Hospital 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.