CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: Northside Hospital Duluth

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$24,717

about 1.8× the $14,044 Medicare rate · typically $15,268–$27,274

modeled estimate · not a bill or quote

What this hospital charges insurers

$19,656

Below the fair price — a good deal

about $5,061 under the fair price · 1.4× Medicare

Medicare pays $14,044 Fair price $24,717 This hospital $19,656

How we calculate the fair BaseRate →

How this hospital compares to other GA hospitals

Highest price of the 9 GA hospitals we have prices for — worth calling around.

Cheapest $10,982 Priciest $19,656

Black dot = this hospital, among the 9 GA hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $24,717 (about 1.8× the $14,044 Medicare rate). Northside Hospital Duluth charges insurers about $19,656 — below the fair price — a good deal. Located in Duluth, GA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$4,634 - $19,656	33%
Blue Cross Blue Shieldmajor	$3,245 - $19,656	23%
Aetnamajor	$3,841 - $20,049	27%
Cignamajor	$6,294 - $20,246	45%
Humanamajor	$17,953 - $19,853	128%
Kaiser Permanentemajor	$3,538 - $20,246	25%
Ambetter (Centene)	$18,664 - $43,642	133%
Amerigroup	$20,442 - $22,889	146%
CareSource	$19,748	141%
Clover Health	$19,748	141%
Health Net	$4,623	33%
WellCare	$18,308 - $20,246	130%
+ 13 smaller / regional plans	$11,041 - $27,601

Government programs also on file: Medicare, Military & VA.

Excludes 5 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm Northside Hospital Duluth is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Northside Hospital Duluth

Compare: Hip or knee replacement (inpatient stay) at other GA hospitals

Coffee Regional Medical Center, Inc · Douglas $10,982
Bacon County Hospital · Alma $12,743
Northside Hospital Forsyth · Cumming $14,215
Phoebe Putney Memorial Hospital · Albany $14,820
Wellstar Paulding Medical Center · Hiram $15,030
Wellstar North Fulton Medical Center · Roswell $15,139
Fairview Park Hospital · Dublin $15,181
Doctors Hospital · Augusta $15,224

Insurance negotiated median for the same procedure, sorted lowest first.