27487

Revision of thigh and lower leg bone components of total knee joint prosthesis

Medicare pricing data for 7,838 providers across 51 states

🤖AI Overview

This procedure has a 5.4x markup — hospitals charge $6,170 but Medicare allows only $1,135. Uninsured patients may face bills 5.4 times higher than what insurance negotiates. Prices vary significantly by location — from $859 in Vermont to $1,785 in District of Columbia. Where you get this procedure matters more than almost any other factor. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Revision of thigh and lower leg bone components of total knee joint prosthesis (HCPCS code 27487) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $1,135, but hospitals typically charge $6,170 — a 5.4x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$227.07

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $1,135, your out-of-pocket cost would be approximately $227.07. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$1,135
Average Hospital Charge
$6,170
Markup Ratio
5.4x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$6,170.28
Medicare Allowed$1,135.35
Medicare Payment$904.00

Hospitals charge 5.4x more than what Medicare allows for this procedure. Medicare actually pays $904.00 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
District of Columbia$1,785$7,3321753+57.2%
Hawaii$1,515$3,8311544+33.4%
New York$1,426$12,8803471,034+25.6%
West Virginia$1,311$4,76338102+15.5%
Massachusetts$1,290$7,799174489+13.6%
California$1,275$5,7835671,895+12.3%
Michigan$1,219$4,649231664+7.4%
Maryland$1,214$5,401162625+6.9%
Illinois$1,212$10,166281968+6.8%
Pennsylvania$1,207$5,7733601,187+6.3%
Virginia$1,202$5,735196679+5.9%
New Jersey$1,201$14,601194640+5.8%
Tennessee$1,187$5,223172584+4.6%
Nevada$1,185$6,36563282+4.4%
Louisiana$1,178$5,311104370+3.8%
Mississippi$1,171$5,09757192+3.1%
Kentucky$1,166$4,212100398+2.7%
Missouri$1,158$6,388150583+2.0%
Georgia$1,145$6,458191508+0.9%
Texas$1,145$5,3625131,934+0.9%
Minnesota$1,141$6,645191510+0.5%
North Dakota$1,141$5,0253494+0.5%
Florida$1,131$5,3985502,089-0.3%
New Mexico$1,130$3,9224087-0.5%
North Carolina$1,092$4,6672981,024-3.8%
Connecticut$1,089$7,609108234-4.1%
Oklahoma$1,087$3,344114475-4.3%
Oregon$1,083$4,92198249-4.6%
New Hampshire$1,065$11,06452194-6.2%
Arizona$1,052$4,208218730-7.4%
South Carolina$1,047$5,518128423-7.7%
Rhode Island$1,043$5,9013191-8.2%
Iowa$1,040$5,88694343-8.4%
Washington$1,034$3,977207568-8.9%
Ohio$1,033$4,6943251,046-9.0%
Wyoming$1,029$7,4303086-9.4%
Colorado$1,022$5,053184611-10.0%
Montana$1,005$4,04250205-11.5%
Utah$1,000$3,59293332-11.9%
Delaware$997$5,57037118-12.2%
Alabama$996$5,733113366-12.3%
Indiana$987$5,496210766-13.0%
Wisconsin$984$12,915177471-13.3%
Arkansas$977$3,78675427-13.9%
Kansas$977$4,570127546-14.0%
Nebraska$962$6,20589341-15.3%
Idaho$936$4,44261259-17.6%
South Dakota$923$4,02364211-18.7%
Maine$906$3,2312887-20.2%
Alaska$881$7,6712582-22.4%
Vermont$859$4,7081537-24.4%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

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