CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Northside Hospital Forsyth

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$24,971

about 1.8× the $14,044 Medicare rate · typically $15,241–$28,989

modeled estimate · not a bill or quote

What this hospital charges insurers

$14,215

Below the fair price — a good deal

about $10,756 under the fair price · 1.0× Medicare

Medicare pays $14,044 Fair price $24,971 This hospital $14,215

How we calculate the fair BaseRate →

How this hospital compares to other GA hospitals

One of the lower prices — 6 of 8 other GA hospitals charge more for the same procedure.

Cheapest $10,982 Priciest $15,444

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

A fair price for a Hip or knee replacement (inpatient stay) is about $24,971 (about 1.8× the $14,044 Medicare rate). Northside Hospital Forsyth charges insurers about $14,215 — below the fair price — a good deal. Located in Cumming, GA.

What each insurance company pays

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

6 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	$4,634 - $13,539	33%
Blue Cross Blue Shieldmajor	$3,245 - $13,539	23%
Aetnamajor	$3,841 - $13,809	27%
Cignamajor	$6,294 - $13,945	45%
Humanamajor	$13,674	97%
Kaiser Permanentemajor	$3,538 - $13,945	25%
Ambetter (Centene)	$14,215 - $43,642	101%
Amerigroup	$22,889	163%
CareSource	$14,215	101%
Clover Health	$14,215	101%
Health Net	$4,623	33%
WellCare	$13,945	99%
+ 13 smaller / regional plans	$11,041 - $27,601

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

Excludes 5 rental-network / third-party entries (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, 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 Northside Hospital Forsyth 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 Northside Hospital Forsyth

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

Coffee Regional Medical Center, Inc · Douglas $10,982
Bacon County Hospital · Alma $12,743
Phoebe Putney Memorial Hospital · Albany $14,820
Wellstar Paulding Medical Center · Hiram $15,030
Wellstar North Fulton Medical Center · Roswell $15,139
Fairview Park Hospital · Dublin $15,181
Doctors Hospital · Augusta $15,224
Memorial Health Meadows Hospital · Vidalia $15,444

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