CMS Price Transparency Data

Total knee replacement

Facility: Unity Physicians Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $11,325
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Unity Physicians Hospital is $11,325. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.86x the Medicare baseline. Located in 4455 Edison Lakes Pkwy, Mishawaka, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,325

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%)

Insurance Median: $11,325 (86%)

Ins. Median: $11,325 (86% 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
Blue Cross Blue Shield	$6,693 - $22,500	51%
Medicaid / KanCare	$6,693	51%
Mhs Hoosier Care Connect	$6,693	51%
All Savers	$7,450 - $23,749	57%
Medica	$7,450 - $23,749	57%
Medica Ifb	$7,450 - $23,749	57%
Oxford	$7,450 - $23,749	57%
UnitedHealthcare	$7,450 - $23,749	57%
Aarp Supplemental	$10,977 - $11,325	84%
Aetna	$10,977 - $11,325	84%
Cigna	$10,977 - $11,325	84%
Department Of Va	$10,977 - $11,325	84%
Medicare (plans)	$10,977 - $11,325	84%
Mhs Healthy Indiana Plan	$10,977 - $11,325	84%
Railroad Retirement	$10,977 - $11,325	84%
Three Rivers Provider Network	$13,172 - $13,590	100%
Humana	$15,367 - $21,000	117%
Encore	$19,758 - $20,386	151%
Provider Network Of America	$21,953 - $22,651	167%
Nalc	$23,749 - $59,651	181%
Sagamore Health Network	$23,749 - $59,651	181%
Multiplan	$64,622	493%
Multiplan Wc	$79,535	606%

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 $X.
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 Unity Physicians 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.