CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Wellstar West Georgia Medical Center

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $23,843
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Wellstar West Georgia Medical Center is $23,843. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.70x the Medicare baseline. Located in 1514 Vernon Road, Lagrange, GA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$23,843

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%)

Insurance Median: $23,843 (170%)

Ins. Median: $23,843 (170% 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
Aetna	$17,215 - $52,268	123%
Cigna	$17,215 - $75,616	123%
Blue Cross Blue Shield	$17,559 - $66,157	125%
Humana	$17,559	125%
UnitedHealthcare	$17,559 - $52,883	125%
Clear Spring	$18,076	129%
Wellcare	$18,076	129%
Clover	$18,420	131%
Pruitt	$18,420	131%
Sonder	$18,420	131%
Oscar Healthplan	$29,265	208%
Ambetter / Centene	$30,298	216%
Peachstate	$31,847	227%
Caresource	$33,741	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 $X.
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 Wellstar West Georgia 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.