CMS Price Transparency Data

Total knee replacement

Facility: Jersey Shore University Medical Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $11,969
Cash Discount Price: $14,242
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Jersey Shore University Medical Center is $11,969. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,242. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.91x the Medicare baseline. Located in 1945 Rte 33, Neptune, NJ.

Cash / Self-Pay

$14,242

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,969

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: $14,242 (109%)

Insurance Median: $11,969 (91%)

Cash: $14,242 (109% of Medicare)

Ins. Median: $11,969 (91% 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
Horizon	$1,827 - $14,615	14%
UnitedHealthcare	$2,379 - $27,512	18%
Aetna	$2,408 - $15,524	18%
Clover	$2,611	20%
Karna	$2,660	20%
Seoul Medical Group	$3,351	26%
Blue Cross Blue Shield	$3,366 - $14,242	26%
Qualcare	$6,256 - $13,173	48%
Brighton Health Plan	$10,163	77%
Bergen Risk	$10,881	83%
Beacon	$10,881	83%
Cigna	$11,606 - $20,267	88%
Multiplan - PHCS	$12,332	94%
Activecare First McO	$12,332	94%
Amerihealth	$12,674 - $14,354	97%
Wellcare	$14,242	109%
Vaccn	$14,242	109%
United Community/Americhoice	$14,954	114%
Oxford	$22,680	173%

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 $14,242.
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 Jersey Shore University 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.