CMS Price Transparency Data

Total knee replacement

Facility: Tops Surgical Specialty Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $4,745
Cash Discount Price: $3,691
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Tops Surgical Specialty Hospital is $4,745. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,691. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.36x the Medicare baseline. Located in 17080 Red Oak Drive, Houston, TX.

Cash / Self-Pay

$3,691

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,745

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: $3,691 (28%)

Insurance Median: $4,745 (36%)

Cash: $3,691 (28% of Medicare)

Ins. Median: $4,745 (36% 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
Oscar Health Plan	$1,608 - $3,824	12%
Ambetter / Centene	$1,841 - $4,848	14%
Health Net	$2,154 - $8,963	16%
Aetna	$2,659 - $9,897	20%
Humana	$3,937 - $7,909	30%
Blue Cross Blue Shield	$4,745 - $5,589	36%
Cigna	$5,137 - $5,394	39%
UnitedHealthcare	$11,664 - $19,468	89%

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 $3,691.
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 Tops Surgical Specialty Hospital 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.