CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Piedmont Fayette Hospital

Billing Code: 470 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 470
Insurance Median: $28,005
Cash Discount Price: $40,779
vs. Medicare Baseline: 1.99x Medicare

The contracted insurance negotiated median rate for a Hip or knee replacement (inpatient stay) at Piedmont Fayette Hospital is $28,005. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40,779. Compared to the federal Medicare reimbursement reference rate of $14,044.15, this hospital’s rate is 1.99x the Medicare baseline. Located in 1255 Highway 54 West, Fayetteville, GA.

Cash / Self-Pay

$40,779

Average discount available for prompt cash payment at this facility.

Insurance Median

$28,005

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: $40,779 (290%)

Insurance Median: $28,005 (199%)

Cash: $40,779 (290% of Medicare)

Ins. Median: $28,005 (199% 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]	$7,561	54%
Medicare (plans)	$16,124 - $16,750	115%
UnitedHealthcare	$16,359 - $43,194	116%
Clear Spring Health Care [30192]	$16,594	118%
Georgia Health Advantage [30143]	$16,750	119%
Ambetter / Centene	$27,935	199%
Aetna	$28,689	204%
Cigna	$29,310 - $45,485	209%
Alliant Solocare [11101]	$31,875	227%
Caresource Marketplace [11106]	$33,657	240%
Alliant Health Plans Of Georgia [10952]	$38,291	273%
Blue Cross Blue Shield	$48,104 - $53,746	343%

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 $40,779.
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 Fayette 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.