CMS Price Transparency Data

Total knee replacement

Facility: Saint Michael's Medical Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 27447
  • Insurance Median: $15,336
  • Cash Discount Price: $14,888
  • vs. Medicare Baseline: 1.17x Medicare
The contracted insurance negotiated median rate for a Total knee replacement at Saint Michael's Medical Center is $15,336. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $14,888. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.17x the Medicare baseline. Located in 111 Central Avenue, Newark, NJ.
Cash / Self-Pay
$14,888

Average discount available for prompt cash payment at this facility.

Insurance Median
$15,336

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: $14,888 (114%)
Insurance Median: $15,336 (117%)
Cash: $14,888 (114% of Medicare)
Ins. Median: $15,336 (117% 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.

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 $7,645 - $14,889 58%
Tricare $11,911 91%
Aetna $14,889 - $31,565 114%
Amerihealth $14,889 114%
Horizon $14,889 - $30,463 114%
Humana $14,889 114%
Medicare (plans) $14,889 114%
New Jersey Out of State $14,889 114%
Wellpoint Amerigroup $14,889 114%
Wellcare $15,336 - $20,100 117%
Clover Health $15,485 118%
Curana $15,633 119%
Employer Direct Healthcare $20,845 159%
Naphcare $23,078 176%
Cigna $23,796 181%
Fairprice Healthcare Holdings - Fphh $23,822 182%
Coventry $29,778 227%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 111 Central Avenue, Newark, NJ 07102
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals