CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: West Penn Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$16,031

about 1.1× the $14,044 Medicare rate · typically $13,991–$20,554

modeled estimate · not a bill or quote

What this hospital charges insurers

$14,876

About the fair price

about $1,155 under the fair price · 1.1× Medicare

Medicare pays $14,044 Fair price $16,031 This hospital $14,876

How we calculate the fair BaseRate →

How this hospital compares to other PA hospitals

Highest price of the 9 PA hospitals we have prices for — worth calling around.

Cheapest $13,221 Priciest $14,876

Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $16,031 (about 1.1× the $14,044 Medicare rate). West Penn Hospital charges insurers about $14,876 — about the fair price. Located in Pittsburgh, PA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$13,774 - $14,876	98%
Blue Cross Blue Shieldmajor	$9,060 - $31,096	65%
Aetnamajor	$14,325 - $41,658	102%
Cignamajor	$14,738 - $39,311	105%
Humanamajor	$14,600	104%
AmeriHealth	$14,463	103%
Geisinger	$14,463 - $20,585	103%
Medical Mutual	$39,311	280%
Molina	$15,014	107%
+ 6 smaller / regional plans	$13,774 - $30,940

Government programs also on file: Medicare.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm West Penn Hospital is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at West Penn Hospital

Compare: Hip or knee replacement (inpatient stay) at other PA hospitals

Chan Soon- Shiong Medical Center at Windber · Windber $13,221
Penn State Health Lancaster Medical Center · Lancaster $13,535
Meadville Medical Center · Meadville $13,726
Allegheny Valley Hospital · Natrona $13,765
Canonsburg General Hospital · Canonsburg $13,776
Advanced Surgical Hospital · Washington $13,991
Ahn Wexford Hospital · Wexford $14,185
Punxsutawney Area Hospital · Punxsutawney $14,210

Insurance negotiated median for the same procedure, sorted lowest first.