CMS Price Transparency Data

Total knee replacement

Facility: Fort Memorial Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $11,504
Cash Discount Price: $4,979
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Fort Memorial Hospital is $11,504. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,979. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.88x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$4,979

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,504

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: $4,979 (38%)

Insurance Median: $11,504 (88%)

Cash: $4,979 (38% of Medicare)

Ins. Median: $11,504 (88% 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
Molina	$1,212 - $12,400	9%
UnitedHealthcare	$1,591 - $12,400	12%
Blue Cross Blue Shield	$3,766 - $12,400	29%
Dean Health Plan	$3,901 - $13,459	30%
Medicaid / KanCare	$3,901	30%
Quartz	$3,901 - $12,400	30%
Fort Care	$4,112	31%
Group Health Cooperative	$4,190 - $9,958	32%
Managed Health Services	$4,252	32%
Aetna	$6,208 - $11,546	47%
Humana	$8,014 - $12,400	61%
Alliance	$11,048	84%
Mercycare	$11,462	87%
Medicare (plans)	$12,400	95%
Trilogy	$13,537	103%
Cigna	$14,626	112%
Veteran Evaluation Services	$15,231	116%
Centivo	$29,243 - $30,462	223%

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 $4,979.
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 Fort Memorial 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.