Northeast Georgia Medical Center Lumpkin
227 Mountain Drive, Dahlonega, GA 30533 · 124 Priced Procedures · 86% Patient Recommendation
Typical commercial prices here are 8% below the fair benchmark (0.92×) after accounting for local nurse/doctor wages and patient complexity.
4-Star CMS clinical quality rating paired with 0.92× fair market pricing.
Uniform Value Leader · Low-Cost Across Departments
Northeast Georgia Medical Center Lumpkin maintains low, disciplined commercial pricing across both routine shoppable procedures (1.7× Medicare, p50 1.01× Fair BaseRate) and emergency/ancillary services (1.2× Medicare, p75 1.06× Fair BaseRate). Both insured and self-pay patients benefit from below-benchmark rates across departments.
Where They're Good (Patient & Payer Edge)
- Elective shoppable care is priced 8% below peer Fair BaseRate (0.92×)
- Self-pay cash beats commercial insurance on 1% of shoppable procedures (99/100 Cash Honesty)
- 5-Star CMS clinical rating with 86% patient recommendation (74/100 safety score)
- IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (6.8% AGB cap)
Where You Can Get Burned (Markup Traps)
- Outpatient surgery & OR suites carry a 2.1× markup over Medicare rates
- Commercial insurance median sits at 1.01× Fair BaseRate (1.7× Medicare), so insured patients should always compare the self-pay cash price before paying.
- Even at low-cost facilities (0.92× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
- Unnegotiated chargemaster list prices average 17.0× Medicare (14¢ true HCRIS cost per $1 gross)
Pre-scheduled outpatient procedures where patients can comparison-shop.
Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.
Detects median-gaming when upper-quartile codes spike above the p50 median.
Procedure Prices at Northeast Georgia Medical Center Lumpkin
High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 124 published procedures.
| Procedure & Billing Code | This Hospital | vs. Fair |
|---|---|---|
| Spinal fusion, single level (inpatient stay) MS-DRG Code: 451 | $68,034 | unverified |
| Heart stent placement (inpatient stay) MS-DRG Code: 322 | $39,886 | unverified |
| Sepsis treatment (inpatient stay) MS-DRG Code: 871 | $31,511 | 1.7× |
| Hip or knee replacement (inpatient stay) MS-DRG Code: 470 | $30,389 | 1.6× |
| Gallbladder removal (laparoscopic) CPT Code: 47562 | $19,238 | unverified |
| Cataract surgery with lens implant CPT Code: 66984 | $16,442 | unverified |
| Total hip replacement CPT Code: 27130 | $13,987 | 1.0× |
| Total knee replacement CPT Code: 27447 | $13,987 | 1.0× |
| Digestive disorders treatment (inpatient stay) MS-DRG Code: 392 | $12,530 | 1.5× |
| Knee arthroscopy with meniscus repair CPT Code: 29881 | $12,066 | unverified |
| Inguinal hernia repair CPT Code: 49505 | $12,066 | unverified |
| Bunion correction surgery CPT Code: 28296 | $9,843 | 2.9× |
| Breast lump removal CPT Code: 19120 | $9,843 | 2.5× |
| Upper endoscopy with biopsy CPT Code: 43239 | $8,563 | unverified |
| Colonoscopy (diagnostic) CPT Code: 45378 | $8,563 | unverified |
| Colonoscopy with biopsy CPT Code: 45380 | $8,563 | unverified |
| Trauma team activation HCPCS Code: G0390 | $4,093 | 2.8× |
| Sleep study (overnight, in lab) CPT Code: 95810 | $3,673 | 3.6× |
| Blood transfusion CPT Code: 36430 | $2,059 | unverified |
| Echocardiogram (heart ultrasound) CPT Code: 93306 | $581 | 1.0× |
| Behavioral health living support HCPCS Code: H2019 | $385 | 11.3× |
| CT scan, abdomen and pelvis (with contrast) CPT Code: 74177 | $376 | 0.8× |
| MRI, brain (with and without contrast) CPT Code: 70553 | $376 | 0.7× |
| Breathing treatment (nebulizer) CPT Code: 94640 | $334 | 1.7× |
| Residential substance abuse treatment HCPCS Code: H2035 | $285 | 3.2× |
Audit a Bill or Quote at Northeast Georgia Medical Center Lumpkin (Zero PHI Required)
Statutory 501(r) AGB Cap Limits Bill to $11,120
At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (6.8% of gross = $11,120).
Compare Prompt-Pay Cash Rate Against Remaining Deductible
Ask Northeast Georgia Medical Center Lumpkin's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.
Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)
Your bill ($163,282) is $132,507 above the denoised Fair BaseRate ($30,775) and 6.9× the $23,504 Medicare rate.
Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)
Hospital-Specific CMS HCRIS Benchmark (6.8% of gross charges)
Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.
Clinical Quality, Patient Experience & Infection Benchmarks
Source: CMS Hospital Care Compare (145 completed HCAHPS patient surveys). Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.
How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings
2D regional comparison of commercial negotiated price index against CMS clinical quality composite for Northeast Georgia Medical Center Lumpkin.
Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings
Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.