CMS Price Transparency Data

Total knee replacement

Facility: Bayshore Medical Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $11,308
Cash Discount Price: $14,242
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Bayshore Medical Center is $11,308. 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 0.86x the Medicare baseline. Located in 727 N Beers St, Holmdel, NJ.

Cash / Self-Pay

$14,242

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,308

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: $11,308 (86%)

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

Ins. Median: $11,308 (86% 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	$1,613 - $11,308	12%
UnitedHealthcare	$2,379 - $26,868	18%
Aetna	$2,875 - $15,524	22%
Clover	$3,156	24%
Seoul Medical Group	$3,278	25%
Qualcare	$6,256 - $10,822	48%
Brighton Health Plan	$9,933	76%
Bergen Risk	$13,148	100%
Amerihealth	$13,972 - $15,795	107%
Cigna	$14,025 - $18,427	107%
Blue Cross Blue Shield	$14,242	109%
Vaccn	$14,242	109%
Wellcare	$14,242	109%
Multiplan - PHCS	$14,901	114%
United Community/Americhoice	$14,954	114%
Oxford	$21,455	164%

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 Bayshore 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.