CMS Price Transparency Data

Total knee replacement

Facility: Hospital for Special Surgery

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $57,702
Cash Discount Price: $79,505
vs. Medicare Baseline: 4.40x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Hospital for Special Surgery is $57,702. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79,505. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 4.40x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$79,505

Average discount available for prompt cash payment at this facility.

Insurance Median

$57,702

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: $79,505 (606%)

Insurance Median: $57,702 (440%)

Cash: $79,505 (606% of Medicare)

Ins. Median: $57,702 (440% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 440% of the Medicare baseline (a markup of 340%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$120 - $76,965	1%
Metro Plus	$899 - $1,474	7%
Fidelis	$1,006 - $1,208	8%
Emblem	$1,342 - $6,415	10%
UnitedHealthcare	$1,342 - $76,712	10%
Aetna	$6,866 - $60,632	52%
Horizon	$7,353	56%
Cigna	$7,575 - $54,668	58%
Nyship	$8,581	65%
Affinity By Molina Health Plan [1005]	$32,692	249%
Fidelis Essential [1323]	$32,692	249%
Apwu [1016]	$54,668	417%
Nalc [1090]	$54,668	417%
Qualcare [1101]	$54,668	417%
Wellfleet [1361]	$54,668	417%
Emblem Health [1043]	$55,185 - $89,438	421%
Christian Brothers [1034]	$60,632	462%
Meritain Health [1085]	$60,632	462%
Nippon Life [1092]	$60,632	462%
Webtpa [1356]	$60,632	462%
Oxford [1096]	$61,508	469%
Connecticare [1039]	$62,711	478%
Geha [1053]	$68,940	526%
Student Resources [1103]	$68,940	526%
Harvard Pilgrim [1057]	$76,712	585%

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 $79,505.
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 Hospital for Special Surgery 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.