CMS Price Transparency Data

Spinal fusion, single level (inpatient stay)

Facility: Conemaugh Memorial Medical Center

Billing Code: 451 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 451
Insurance Median: $28,276
Cash Discount Price: $30,642
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Spinal fusion, single level (inpatient stay) at Conemaugh Memorial Medical Center is $28,276. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $30,642. Compared to the federal Medicare reimbursement reference rate of $23,503.93, this hospital’s rate is 1.20x the Medicare baseline. Located in 1086 Franklin Street, Johnstown, PA.

Cash / Self-Pay

$30,642

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,276

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$23,503.93

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $23,503.93 (100%)

Cash / Self-Pay: $30,642 (130%)

Insurance Median: $28,276 (120%)

Cash: $30,642 (130% of Medicare)

Ins. Median: $28,276 (120% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $23,503.93 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	$24,225	103%
American Progressive	$27,131	115%
Cigna	$27,131 - $37,109	115%
Geisinger	$27,131 - $50,067	115%
Senior Life	$27,131	115%
UnitedHealthcare	$27,131 - $42,531	115%
Amerihealth Caritas Health Plan	$27,673	118%
Gateway	$27,945	119%
Aetna	$28,216 - $38,575	120%
Upmc Health Plan	$28,276 - $35,915	120%
Blue Cross Blue Shield	$28,777 - $58,039	122%
Tricare	$35,406	151%
Ambetter / Centene	$55,270	235%

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 $30,642.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 451.

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 451.
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.