CMS Price Transparency Data

Total knee replacement

Facility: Sisters of Charity Hospital

Billing Code: 27447 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 27447
Insurance Median: $1,284
Cash Discount Price: $4,138
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Total knee replacement at Sisters of Charity Hospital is $1,284. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,138. Compared to the federal Medicare reimbursement reference rate of $13,116.76, this hospital’s rate is 0.10x the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$4,138

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,284

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: $4,138 (32%)

Insurance Median: $1,284 (10%)

Cash: $4,138 (32% of Medicare)

Ins. Median: $1,284 (10% 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
Independent Health Essential [100166]	$749	6%
Amerigroup [350102]	$749	6%
Excellus Rochester McD [350117]	$749	6%
Medicaid / KanCare	$749 - $1,223	6%
Crime Victims [100176]	$749	6%
Vna Option Mltc [350110]	$749	6%
Blue Cross Blue Shield	$749 - $1,754	6%
Tuscarora Nation [550120]	$749	6%
UnitedHealthcare	$856 - $1,474	7%
Univera Healthcare Essential [100170]	$1,055	8%
Univera Healthcare [100169]	$1,055 - $1,551	8%
Beacon Essential [350122]	$1,100 - $1,467	8%
VA Veterans Affairs [700001]	$1,100	8%
Medicare (plans)	$1,203 - $1,374	9%
Champ VA [700002]	$1,223	9%
Fallon Health [450115]	$1,223	9%
Tricare	$1,223	9%
Covid19 Hrsa [45013]	$1,223	9%
Cigna	$1,223 - $1,773	9%
Hospice [550001]	$1,223	9%
Seneca Nation [450119]	$1,223	9%
Catholic Health Life Pace [400005]	$1,223	9%
Wellcare Fidelis Dual [450451]	$1,284	10%
Aetna	$1,284	10%
Humana	$1,284	10%
Fidelis Dual Advantage [450120]	$1,284	10%
Ghi [100153]	$1,345	10%
Fidelis Essential [100163]	$1,345	10%
Wellcare [450129]	$1,345	10%
Beacon Health Options [100023]	$1,467	11%
Fidelis Exchange [100164]	$1,467	11%
Iha First Choice [800001]	$1,602	12%
Independent Health [100165]	$1,602	12%
Mvp Healthcare [100168]	$1,667	13%
Molina Essential [100167]	$1,685	13%
UPMC Health Plan [100181]	$2,201	17%
No Fault [114001]	$3,941	30%
Workers Compensation [500101]	$3,941	30%
Federal Workers Compensation [500100]	$3,941	30%

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 $4,138.
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 Sisters of Charity 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.