CMS Price Transparency Data

Total knee replacement

Facility: Tomah Memorial Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $1,203
Cash Discount Price: $748
vs. Medicare Baseline: 0.09x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Tomah Memorial Hospital is $1,203. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $748. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.09x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$748

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,203

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: $748 (6%)

Insurance Median: $1,203 (9%)

Cash: $748 (6% of Medicare)

Ins. Median: $1,203 (9% 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
UnitedHealthcare	$893 - $1,740	7%
Blue Cross Blue Shield	$1,050 - $2,839	8%
Group Hlth Mcr Adv - All Plans	$1,050	8%
Independent Care Mcr - All Other Plans	$1,050	8%
Quartz Mcr Adv	$1,050	8%
Security Hp Mcr Adv	$1,050	8%
Va Ccn - All Plans	$1,050	8%
Aetna	$1,105 - $1,208	8%
Security Hp Comm - All Other Plans	$1,105	8%
Quartz Comm - All Other Plans	$1,170	9%
Humana	$1,202	9%
Independent Care Mcaid	$1,203	9%
Managed Hlth Mcaid - All Plans	$1,203	9%
Quartz Mcaid	$1,203	9%
Security Hp Mcaid	$1,203	9%
Cigna	$1,261	10%
The Alliance - All Plans	$4,463	34%

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 $748.
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 Tomah 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.