CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Piedmont Macon North Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $25,536
Cash Discount Price: $38,829
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Piedmont Macon North Hospital is $25,536. 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 1.82x the Medicare baseline. Located in 400 Charter Boulevard, Macon, GA.

Cash / Self-Pay

$38,829

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,536

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: $25,536 (182%)

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

Ins. Median: $25,536 (182% 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
Medicare (plans)	$12,573 - $13,061	90%
UnitedHealthcare	$12,756 - $44,347	91%
Clear Spring Health Care [30192]	$12,939	92%
Georgia Health Advantage [30143]	$13,061	93%
Blue Cross Blue Shield	$20,289 - $43,189	144%
Ambetter / Centene	$24,828	177%
Caresource Marketplace [11106]	$26,244	187%
Aetna	$28,689	204%
Phcs [10601]	$39,982	285%
Cigna	$45,823	326%

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 Macon North 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.