CMS Price Transparency Data

Total knee replacement

Facility: Lehigh Valley Hospital - Pocono

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $14,227
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Lehigh Valley Hospital - Pocono is $14,227. 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 1.08x the Medicare baseline. Located in 206 East Brown Street, East Stroudsburg, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$14,227

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: $14,227 (108%)

Ins. Median: $14,227 (108% 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
Amerihealth Caritas	$854	7%
Geisinger	$854 - $31,827	7%
UnitedHealthcare	$892 - $13,959	7%
Highmark Wholecare/Gateway	$986	8%
Aetna	$1,009 - $74,438	8%
Jefferson Health Partners	$1,048 - $26,844	8%
Pa Health & Wellness	$1,048	8%
Upmc	$1,277 - $65,365	10%
Highmark Blue Shield	$13,690 - $59,954	104%
Amerihealth	$13,825	105%
Cigna	$13,825	105%
Devoted Health	$14,227	108%
Humana	$14,227	108%
Gateway	$14,361	109%
Emblem	$14,496 - $77,579	111%
Pa Health & Wellness (Allwell)	$14,764	113%
Ambetter / Centene	$40,709	310%
Valley Preferred	$78,270	597%

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 Lehigh Valley Hospital - Pocono 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.