CMS Price Transparency Data

Heart stent placement (inpatient stay)

Facility: Piedmont Newnan Hospital, Inc

Billing Code: 322 (MS-DRG)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 322
Insurance Median: $25,698
Cash Discount Price: $42,048
vs. Medicare Baseline: 2.01x Medicare

The contracted insurance negotiated median rate for a Heart stent placement (inpatient stay) at Piedmont Newnan Hospital, Inc is $25,698. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42,048. Compared to the federal Medicare reimbursement reference rate of $12,807.1, this hospital’s rate is 2.01x the Medicare baseline. Located in 745 Poplar Road, Newnan, GA.

Cash / Self-Pay

$42,048

Average discount available for prompt cash payment at this facility.

Insurance Median

$25,698

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$12,807.1

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $12,807.1 (100%)

Cash / Self-Pay: $42,048 (328%)

Insurance Median: $25,698 (201%)

Cash: $42,048 (328% of Medicare)

Ins. Median: $25,698 (201% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $12,807.1 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 201% of the Medicare baseline (a markup of 101%). 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
Medicare (plans)	$15,120 - $15,708	118%
UnitedHealthcare	$15,341 - $39,479	120%
Clear Spring Health Care [30192]	$15,561	122%
Georgia Health Advantage [30143]	$15,708	123%
Ambetter / Centene	$25,698	201%
Aetna	$26,221	205%
Cigna	$28,210 - $41,882	220%
Alliant Solocare [11101]	$29,891	233%
Caresource Marketplace [11106]	$31,562	246%
Alliant Health Plans Of Georgia [10952]	$34,997	273%
Blue Cross Blue Shield	$43,967 - $49,123	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 $42,048.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify MS-DRG Code matches exactly: 322.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Piedmont Newnan Hospital, Inc is fully in-network.
Ask your insurer if "Prior Authorization" is required for MS-DRG code 322.
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.