CMS Price Transparency Data

Total knee replacement

Facility: Guadalupe Regional Medical Center

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $12,540
Cash Discount Price: $16,100
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Guadalupe Regional Medical Center is $12,540. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,100. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.96x the Medicare baseline. Located in 1215 E Court St, Seguin, TX.

Cash / Self-Pay

$16,100

Average discount available for prompt cash payment at this facility.

Insurance Median

$12,540

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: $16,100 (123%)

Insurance Median: $12,540 (96%)

Cash: $16,100 (123% of Medicare)

Ins. Median: $12,540 (96% 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
Aetna	$1,119 - $27,370	9%
Christus Exchange Health Plan	$1,119 - $12,540	9%
Mcr Clover Health	$1,119 - $12,540	9%
Mcr Texas Independence Health	$1,119 - $12,540	9%
Mcr Wellcare	$1,119 - $12,540	9%
Oscar Health Plan	$1,119 - $12,540	9%
Va Triwest Health Alliance	$1,119 - $12,540	9%
Superior Hlth Plan Mmcd	$14,490	110%
Healthcare Highways	$24,150	184%
UnitedHealthcare	$24,150	184%
Humana	$27,370	209%
Cigna	$28,980	221%
Texas Mutual Insurance Co	$28,980	221%

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 $16,100.
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 Guadalupe Regional Medical 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.