CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Conemaugh Memorial Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $17,276
Cash Discount Price: $33,832
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Conemaugh Memorial Medical Center is $17,276. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33,832. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.23x the Medicare baseline. Located in 1086 Franklin Street, Johnstown, PA.

Cash / Self-Pay

$33,832

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,276

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: $33,832 (241%)

Insurance Median: $17,276 (123%)

Cash: $33,832 (241% of Medicare)

Ins. Median: $17,276 (123% 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
Devoted Health	$14,801	105%
American Progressive	$16,577	118%
Cigna	$16,577 - $22,673	118%
Geisinger	$16,577 - $30,590	118%
Senior Life	$16,577	118%
UnitedHealthcare	$16,577 - $25,986	118%
Amerihealth Caritas Health Plan	$16,908	120%
Gateway	$17,074	122%
Aetna	$17,240 - $23,569	123%
Upmc Health Plan	$17,276 - $21,944	123%
Blue Cross Blue Shield	$17,582 - $22,832	125%
Tricare	$22,632	161%
Ambetter / Centene	$33,769	240%

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 $33,832.
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 Conemaugh Memorial Medical Center 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.