CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Conemaugh Memorial Medical Center

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 871
Insurance Median: $17,940
Cash Discount Price: $16,730
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Conemaugh Memorial Medical Center is $17,940. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16,730. Compared to the federal Medicare reimbursement reference rate of $14,116.91, this hospital’s rate is 1.27x the Medicare baseline. Located in 1086 Franklin Street, Johnstown, PA.

Cash / Self-Pay

$16,730

Average discount available for prompt cash payment at this facility.

Insurance Median

$17,940

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$14,116.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,116.91 (100%)

Cash / Self-Pay: $16,730 (119%)

Insurance Median: $17,940 (127%)

Cash: $16,730 (119% of Medicare)

Ins. Median: $17,940 (127% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,116.91 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	$15,402	109%
Tricare	$17,084	121%
American Progressive	$17,250	122%
Cigna	$17,250 - $23,594	122%
Geisinger	$17,250 - $31,833	122%
Senior Life	$17,250	122%
UnitedHealthcare	$17,250 - $27,042	122%
Amerihealth Caritas Health Plan	$17,595	125%
Gateway	$17,767	126%
Aetna	$17,940 - $24,526	127%
Upmc Health Plan	$17,978 - $22,835	127%
Blue Cross Blue Shield	$18,297 - $25,860	130%
Ambetter / Centene	$35,141	249%

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 $16,730.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 871.

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 871.
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.