CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Piedmont Columbus Regional Midtown

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $31,033
Cash Discount Price: $38,829
vs. Medicare Baseline: 2.21x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Piedmont Columbus Regional Midtown is $31,033. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38,829. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.21x the Medicare baseline. Located in 710 Center Street, Columbus, GA.

Cash / Self-Pay

$38,829

Average discount available for prompt cash payment at this facility.

Insurance Median

$31,033

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%)

Cash / Self-Pay: $38,829 (276%)

Insurance Median: $31,033 (221%)

Cash: $38,829 (276% of Medicare)

Ins. Median: $31,033 (221% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 221% of the Medicare baseline (a markup of 121%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Phcs [10601]	$7,561	54%
Medicare (plans)	$17,308 - $17,980	123%
UnitedHealthcare	$17,560 - $56,316	125%
Clear Spring Health Care [30192]	$17,812	127%
Georgia Health Advantage [30143]	$17,980	128%
Ambetter / Centene	$27,175	193%
Cigna	$27,375 - $39,787	195%
Blue Cross Blue Shield	$30,754 - $47,619	219%
Alliant Solocare [11101]	$35,415	252%
Aetna	$36,292	258%
Caresource Marketplace [11106]	$37,394	266%
Alliant Health Plans Of Georgia [10952]	$38,291	273%

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 $38,829.
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 Piedmont Columbus Regional Midtown 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.