CMS Price Transparency Data

Total knee replacement

Facility: Harlem Hospital Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $4,254
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.32x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Harlem Hospital Center is $4,254. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.32x the Medicare baseline. Located in 506 Lenox Avenue, New York, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,254

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%)

Insurance Median: $4,254 (32%)

Ins. Median: $4,254 (32% 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
United	$957 - $5,213	7%
Healthfirst	$1,172 - $9,383	9%
Amidacare	$1,465	11%
Emblem	$1,465 - $22,839	11%
Wellcare	$1,583	12%
Metroplus	$1,869 - $4,170	14%
Fidelis	$2,110 - $21,621	16%
Blue Cross Blue Shield	$4,170 - $15,226	32%
Carelon	$4,170	32%
Senior Whole Health	$4,170	32%
United Behavioral Health	$4,170 - $4,587	32%
Affinity	$4,254 - $9,383	32%
Carelon (Amida Care)	$4,254	32%
Vnsny	$4,254 - $15,226	32%
Aetna	$15,226	116%
Vaccn	$15,226	116%
Centers Plan For Healthy Living	$15,835	121%
Oscar	$22,839	174%
Elderplan	$30,452	232%

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 $X.
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 Harlem Hospital 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.