CMS Price Transparency Data

Total knee replacement

Facility: Carolina East Medical Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $3,849
Cash Discount Price: $3,308
vs. Medicare Baseline: 0.29x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Carolina East Medical Center is $3,849. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,308. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.29x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$3,308

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,849

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: $3,308 (25%)

Insurance Median: $3,849 (29%)

Cash: $3,308 (25% of Medicare)

Ins. Median: $3,849 (29% 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
Humana	$1,085	8%
Inclusive Health (Nchirp)-All Plans	$1,085	8%
Tricare	$1,085	8%
Pamlico Co Jail-All Plans	$1,466	11%
UnitedHealthcare	$1,930	15%
Craven Co. Jail Systems - All Plans	$2,297	18%
Medcost Ppo Employees And Retirees	$3,620	28%
Medcost Ppo Ultra (Employees)	$3,620	28%
Blue Cross Blue Shield	$3,849	29%
Medcost Ppo City Employees	$4,016	31%
Medcost Ppo County Employee	$4,176	32%
Benefit Mgmt, Svcs-All Plans	$4,686	36%
Medcost Benefit Svc-All Other Plans	$4,872	37%
Aetna	$4,885	37%
Acs Consult Svc Inc-All Plans	$4,979	38%
Medcost Ppo Standard	$4,979	38%
Cigna	$5,017	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 $3,308.
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 Carolina East 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.