CMS Price Transparency Data

Total knee replacement

Facility: Carewell Health Medical Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $14,436
Cash Discount Price: $28,233
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Carewell Health Medical Center is $14,436. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28,233. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.10x the Medicare baseline. Located in 300 Central Ave, East Orange, NJ.

Cash / Self-Pay

$28,233

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,436

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: $28,233 (215%)

Insurance Median: $14,436 (110%)

Cash: $28,233 (215% of Medicare)

Ins. Median: $14,436 (110% 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 New Jersey Health	$1,208 - $14,436	9%
Clover	$1,387 - $14,436	11%
UnitedHealthcare	$1,387 - $14,436	11%
Wellcare	$1,387 - $14,436	11%
Oxford Health Plan	$4,037	31%
Amerigroup	$5,919	45%
Aetna	$6,421 - $28,233	49%
Magnacare	$21,590	165%
Blue Cross Blue Shield	$32,696	249%

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 $28,233.
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 Carewell Health 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.