CMS Price Transparency Data

CT scan, sinuses

Facility: Northside Hospital Forsyth

Billing Code: 70486 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 70486
  • Insurance Median: $1,141
  • Cash Discount Price: $2,946
  • vs. Medicare Baseline: 10.68x Medicare
The contracted insurance negotiated median rate for a CT scan, sinuses at Northside Hospital Forsyth is $1,141. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,946. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 10.68x the Medicare baseline. Located in 1200 Northside Forsyth Drive, Cumming, GA.
Cash / Self-Pay
$2,946

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,141

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $2,946 (2758%)
Insurance Median: $1,141 (1068%)
Cash: $2,946 (2758% of Medicare)
Ins. Median: $1,141 (1068% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 1068% of the Medicare baseline (a markup of 968%). 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
Champus Va $87 81%
Blue Cross Blue Shield $104 - $2,738 97%
Clear Springs Eon Health $104 97%
Medicare (plans) $104 - $127 97%
UnitedHealthcare $104 - $1,307 97%
Va Ccn $104 97%
Bccp $106 99%
Cbww $106 99%
Humana $106 - $109 99%
Tricare $106 99%
Aetna $107 - $1,455 100%
Coventry $107 - $2,671 100%
Caresource $108 - $1,461 101%
Kaiser $108 - $1,483 101%
Wellcare $108 101%
Clover Health $110 103%
Pruitt Health Premier $110 103%
Us Dept Of Labor Wc $133 125%
Streamline Imaging $138 129%
One Call Diagnostics $194 182%
Mti $216 202%
Genex/Priority Care Solutions $223 209%
Spreemo $223 209%
Homelink $229 214%
Fairly Group $237 222%
Authentic 4D $251 235%
Direct Pay Provider Network Llc $251 235%
Corvel Workers Comp $265 248%
Employers Choice Network $265 248%
Fieldale Farms Wc $279 261%
Georgia Workers Compensation $279 261%
Truths Community $379 355%
Med Care Solutions $430 403%
Medlien Healthcare Services $430 403%
Health One Alliance_Ppo $450 421%
Ambetter / Centene $473 - $731 443%
Amerigroup $473 - $559 443%
Medicaid / KanCare $473 - $544 443%
Cigna $564 - $1,387 528%
Oscar $695 651%
Good Samaritan Radiology $785 735%
Northside Health Network $1,448 1356%
Georgia Reproductive Specialists $1,571 1471%
Quick Trip $2,160 2022%
Novanet_Ppo $2,750 2575%
Phcs $2,946 2758%
Beech Steet $3,339 3126%
Multiplan $3,339 3126%
Multiplan Workers Comp $3,339 3126%
Careiq $3,928 3678%
Dekalb_Department Of Health $3,928 3678%
Fifa $3,928 3678%
Institutional Marietta Surgery Center $3,928 3678%
Institutional Veterans Evaluation Services $3,928 3678%
Rabun County Boc $3,928 3678%

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