CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Piedmont Rockdale Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $28,036
Cash Discount Price: $41,628
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Piedmont Rockdale Hospital is $28,036. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41,628. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 2.00x the Medicare baseline. Located in 1412 Milstead Avenue, Ne, Conyers, GA.

Cash / Self-Pay

$41,628

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,036

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: $41,628 (296%)

Insurance Median: $28,036 (200%)

Cash: $41,628 (296% of Medicare)

Ins. Median: $28,036 (200% 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
Phcs [10601]	$1,900	14%
Medicare (plans)	$17,482 - $18,161	124%
UnitedHealthcare	$17,737 - $43,194	126%
Clear Spring Health Care [30192]	$17,991	128%
Georgia Health Advantage [30143]	$18,161	129%
Ambetter / Centene	$27,996	199%
Aetna	$30,781	219%
Cigna	$30,864 - $45,823	220%
Alliant Solocare [11101]	$34,561	246%
Caresource Marketplace [11106]	$36,492	260%
Alliant Health Plans Of Georgia [10952]	$38,291	273%
Blue Cross Blue Shield	$41,287 - $43,189	294%

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 $41,628.
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 Rockdale Hospital 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.