CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Geisinger-Lewistown Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $23,455
Cash Discount Price: $47,570
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Geisinger-Lewistown Hospital is $23,455. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47,570. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.67x the Medicare baseline. Located in 400 Highland Avenue, Lewistown, PA.

Cash / Self-Pay

$47,570

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,455

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,044.15

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,044.15 (100%)

Cash / Self-Pay: $47,570 (339%)

Insurance Median: $23,455 (167%)

Cash: $47,570 (339% of Medicare)

Ins. Median: $23,455 (167% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,044.15 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
Geisinger Health Plan	$11,389 - $16,178	81%
Medicare (plans)	$11,389	81%
Upmc Health Plan	$11,389 - $22,419	81%
Advantra	$11,503	82%
Blue Cross Blue Shield	$11,503 - $59,480	82%
Humana	$11,503	82%
Ambetter / Centene	$23,918	170%
Aetna	$36,796 - $37,288	262%
Christian Healthcare Ministries	$38,363	273%
Cigna	$40,358	287%
Christian Health Aid	$61,380	437%
Three Rivers Provider Network Inc.	$61,380	437%
Multiplan	$65,217	464%
Healthsmart Payors Organization	$69,053	492%

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 $47,570.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 470.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Geisinger-Lewistown Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 470.
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.