CMS Price Transparency Data

Total knee replacement

Facility: Sidney Health Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $4,937
Cash Discount Price: $3,218
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Sidney Health Center is $4,937. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,218. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.38x the Medicare baseline. Located in 216 14Th Ave Sw, Sidney, MT.

Cash / Self-Pay

$3,218

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,937

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: $3,218 (25%)

Insurance Median: $4,937 (38%)

Cash: $3,218 (25% of Medicare)

Ins. Median: $4,937 (38% 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
UnitedHealthcare	$1,197 - $4,937	9%
Aetna	$1,995 - $4,937	15%
Allegiance	$2,076 - $4,937	16%
Blue Cross Blue Shield	$2,076 - $5,197	16%
Cigna	$2,076 - $4,937	16%
Employee Benefit Management System	$2,088 - $4,937	16%
Sanford Health Plan	$2,232 - $4,937	17%
Mountain Health Co-Op	$2,247 - $5,041	17%
Pacific Source	$4,937	38%

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 $3,218.
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 Sidney Health 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.