CMS Price Transparency Data

Total knee replacement

Facility: Penobscot Valley Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $1,239
Cash Discount Price: $1,149
vs. Medicare Baseline: 0.09x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Penobscot Valley Hospital is $1,239. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,149. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.09x the Medicare baseline. Located in 7 Transalpine Road, Po Box 368, Lincoln, ME.

Cash / Self-Pay

$1,149

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,239

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: $1,149 (9%)

Insurance Median: $1,239 (9%)

Cash: $1,149 (9% of Medicare)

Ins. Median: $1,239 (9% 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
Medicare (plans)	$169 - $2,141	1%
Wellcare Health Plan Inc Mcr Adv	$171 - $1,067	1%
Humana	$194 - $1,227	1%
UnitedHealthcare	$194 - $2,185	1%
Aetna	$198 - $4,462	2%
Blue Cross Blue Shield	$200 - $1,696	2%
Cigna	$1,298 - $4,369	10%
Harvard Pilgrim Healthcare	$1,318 - $4,439	10%

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 $1,149.
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 Penobscot Valley 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.