CMS Price Transparency Data

Total knee replacement

Facility: Astria Toppenish Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $8,400
Cash Discount Price: $3,290
vs. Medicare Baseline: 0.64x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Astria Toppenish Hospital is $8,400. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,290. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.64x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$3,290

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,400

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: $3,290 (25%)

Insurance Median: $8,400 (64%)

Cash: $3,290 (25% of Medicare)

Ins. Median: $8,400 (64% 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
Medicaid / KanCare	$774 - $23,492	6%
Premera_Affordable_Care	$1,908	15%
Chpw_Cascade_Care	$3,189	24%
First_Choice	$3,493	27%
Tpsc	$3,948	30%
Medicare (plans)	$4,181 - $13,424	32%
UnitedHealthcare	$4,181 - $8,400	32%
Aetna	$4,455 - $13,424	34%
Bcchp	$4,695	36%
Great_Rivers	$5,062	39%
Healthcomp	$5,062	39%
Humana	$5,062 - $13,424	39%
Washington_State_Hca	$5,062	39%
Ambetter / Centene	$8,400	64%
Va	$8,560	65%
Molina	$8,568	65%
Molina_Exchange	$10,920	83%
Li	$13,080	100%
Cigna	$13,424	102%
Tricare	$13,424	102%
Zenith	$13,558	103%
Kaiser	$50,029	381%

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 $3,290.
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 Astria Toppenish 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.