CMS Price Transparency Data

Blood test, lipase

Facility: Northside Hospital Forsyth

Billing Code: 83690 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 83690
  • Insurance Median: $172
  • Cash Discount Price: $234
  • vs. Medicare Baseline: 24.96x Medicare
The contracted insurance negotiated median rate for a Blood test, lipase at Northside Hospital Forsyth is $172. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $234. Compared to the federal Medicare reimbursement reference rate of $6.89, this hospital’s rate is 24.96x the Medicare baseline. Located in 1200 Northside Forsyth Drive, Cumming, GA.
Cash / Self-Pay
$234

Average discount available for prompt cash payment at this facility.

Insurance Median
$172

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$6.89

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $6.89 (100%)
Cash / Self-Pay: $234 (3396%)
Insurance Median: $172 (2496%)
Cash: $234 (3396% of Medicare)
Ins. Median: $172 (2496% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $6.89 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 2496% of the Medicare baseline (a markup of 2396%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Fairly Group $5 73%
Aetna $7 - $62 102%
Bccp $7 102%
Blue Cross Blue Shield $7 - $217 102%
Caresource $7 - $116 102%
Cbww $7 102%
Champus Va $7 102%
Clear Springs Eon Health $7 102%
Clover Health $7 102%
Coventry $7 - $212 102%
Humana $7 102%
Kaiser $7 - $271 102%
Medicaid / KanCare $7 - $8 102%
Medicare (plans) $7 - $8 102%
Pruitt Health Premier $7 102%
Tricare $7 102%
UnitedHealthcare $7 - $50 102%
Va Ccn $7 102%
Wellcare $7 102%
Ambetter / Centene $8 - $58 116%
Us Dept Of Labor Wc $9 131%
Amerigroup $10 - $44 145%
Oscar $10 145%
Streamline Imaging $10 145%
Corvel Workers Comp $11 160%
Employers Choice Network $11 160%
Georgia Workers Compensation $11 160%
Cigna $45 - $197 653%
Northside Health Network $94 1364%
Georgia Reproductive Specialists $125 1814%
Medlien Healthcare Services $125 1814%
Med Care Solutions $140 2032%
Health One Alliance_Ppo $172 2496%
Quick Trip $172 2496%
Novanet_Ppo $218 3164%
Phcs $234 3396%
Beech Steet $265 3846%
Multiplan $265 3846%
Multiplan Workers Comp $265 3846%
Careiq $312 4528%
Dekalb_Department Of Health $312 4528%
Fifa $312 4528%
Institutional Marietta Surgery Center $312 4528%
Institutional Veterans Evaluation Services $312 4528%
Rabun County Boc $312 4528%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1200 Northside Forsyth Drive, Cumming, GA 30041
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals