CMS Price Transparency Data

Total knee replacement

Facility: Down East Community Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $4,311
Cash Discount Price: $3,888
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Down East Community Hospital is $4,311. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,888. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.33x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$3,888

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,311

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: $3,888 (30%)

Insurance Median: $4,311 (33%)

Cash: $3,888 (30% of Medicare)

Ins. Median: $4,311 (33% 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	$2,281 - $4,183	17%
Humana	$2,281	17%
Wellcare	$2,281	17%
Partners Direct Health	$2,592	20%
Community Health Options	$4,292	33%
Aetna	$4,329	33%
UnitedHealthcare	$4,458	34%
Martins Point	$4,666	36%
Patients Advocates	$4,666	36%
Cigna	$4,676	36%
Harvard Pilgrim	$4,743	36%

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 $3,888.
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 Down East Community 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.