CMS Price Transparency Data

Total knee replacement

Facility: Stoughton Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $1,480
Cash Discount Price: $7,918
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Stoughton Hospital is $1,480. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,918. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.11x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$7,918

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,480

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: $7,918 (60%)

Insurance Median: $1,480 (11%)

Cash: $7,918 (60% of Medicare)

Ins. Median: $1,480 (11% 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
Healthnet Mcr Adv - All Plans	$893	7%
Tricare	$893	7%
Aetna	$1,050 - $11,229	8%
Dean Health Insurance Med Adv	$1,050	8%
Quartz Mcr Adv	$1,050	8%
Security Health/First Health - All Plans	$1,050	8%
UnitedHealthcare	$1,050 - $11,517	8%
Medicaid / KanCare	$1,337	10%
Dean Health Insurance Comm - All Other Plans	$1,396	11%
Dean Health Insurance Epo	$1,396	11%
Humana	$1,480 - $12,956	11%
Wps - All Plans	$1,545	12%
Blue Cross Blue Shield	$2,582	20%
Quartz Health Solutions - All Other Lans	$2,741	21%
Alliance - All Plans	$3,886	30%
Geha - All Plans	$10,797	82%
Cigna	$11,517	88%
Wisconsin Ppo Ppa Direct - All Plans	$11,517	88%

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 $7,918.
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 Stoughton 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.