CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Roxborough Memorial Hospital

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$18,642

about 1.3× the $14,044 Medicare rate · typically $15,171–$24,644

modeled estimate · not a bill or quote

What this hospital charges insurers

$18,799

About the fair price

about $157 over the fair price · 1.3× Medicare

Medicare pays $14,044 Fair price $18,642 This hospital $18,799 Cash price $18,251

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 $18,799

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 $18,642 (about 1.3× the $14,044 Medicare rate). Roxborough Memorial Hospital charges insurers about $18,799, or about $18,251 in cash — about the fair price. Located in Philadelphia, PA.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Cigna✓ Humana AetnaKaiser 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	$15,361 - $18,757	109%
Blue Cross Blue Shieldmajor	$15,361 - $33,410	109%
Cignamajor	$25,502	182%
Humanamajor	$16,090	115%
HealthPartners	$15,361 - $22,375	109%
+ 8 smaller / regional plans	$15,361 - $23,727

Government programs also on file: Medicare, Military & VA.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 (about 18,251), 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 Roxborough Memorial 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 Roxborough Memorial 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.