CMS Price Transparency Data

Total knee replacement

Facility: Avita Ontario

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $13,117
Cash Discount Price: $82,952
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Avita Ontario is $13,117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82,952. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 1.00x the Medicare baseline. Located in 715 Richland Mall, Ontario, OH.

Cash / Self-Pay

$82,952

Average discount available for prompt cash payment at this facility.

Insurance Median

$13,117

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: $82,952 (632%)

Insurance Median: $13,117 (100%)

Cash: $82,952 (632% of Medicare)

Ins. Median: $13,117 (100% 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
Blue Cross Blue Shield	$1,545 - $69,582	12%
Buckeye	$1,545 - $13,117	12%
Caresource	$1,545	12%
Humana	$1,545 - $13,117	12%
Medicaid / KanCare	$1,545	12%
Molina	$1,545 - $13,117	12%
United_Healthcare	$1,545 - $70,510	12%
Amerihealth	$2,638	20%
Aetna	$13,117 - $97,591	100%
Medical_Mutual	$13,117 - $78,073	100%
Medicare (plans)	$13,117	100%
Mount_Carmel	$13,117	100%
Cigna	$76,023	580%

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 $82,952.
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 Avita Ontario 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.