CMS Price Transparency Data

Total knee replacement

Facility: Albany Medical Center Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $1,407
Cash Discount Price: $1,971
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Albany Medical Center Hospital is $1,407. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,971. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.11x the Medicare baseline. Located in 43 New Scotland Avenue, Mail Code 34, Albany, NY.

Cash / Self-Pay

$1,971

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,407

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: $1,971 (15%)

Insurance Median: $1,407 (11%)

Cash: $1,971 (15% of Medicare)

Ins. Median: $1,407 (11% 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
Magnacare	$237	2%
Medicaid / KanCare	$749 - $1,179	6%
Cdphp	$815 - $15,226	6%
Medicare (plans)	$898 - $1,374	7%
Fidelis	$943 - $26,037	7%
Blue Cross Blue Shield	$988 - $15,226	8%
Tricare	$1,018 - $1,198	8%
Hamaspik	$1,120 - $20,707	9%
Blue Shield Highmark	$1,142 - $2,694	9%
UnitedHealthcare	$1,198 - $2,979	9%
Mvp	$1,206 - $14,465	9%
Aetna	$1,246 - $15,987	9%
Nascentia	$1,318	10%
Emblem Health Ghi	$1,330 - $2,599	10%
Cigna	$1,883 - $2,278	14%
Blue Shield	$2,359 - $4,404	18%
Nys Department Of Corrections	$2,939	22%
Mvp Essential Plan	$8,924	68%
Empire Plan Nyship	$10,729	82%

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 $1,971.
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 Albany Medical Center Hospital 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.