CMS Price Transparency Data

Diagnostic mammogram (both breasts)

Facility: Northside Hospital Forsyth

Billing Code: 77066 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 77066
  • Insurance Median: $401
  • Cash Discount Price: $945
  • vs. Medicare Baseline: 2.55x Medicare
The contracted insurance negotiated median rate for a Diagnostic mammogram (both breasts) at Northside Hospital Forsyth is $401. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $945. Compared to the federal Medicare reimbursement reference rate of $156.98, this hospital’s rate is 2.55x the Medicare baseline. Located in 1200 Northside Forsyth Drive, Cumming, GA.
Cash / Self-Pay
$945

Average discount available for prompt cash payment at this facility.

Insurance Median
$401

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$156.98

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $156.98 (100%)
Cash / Self-Pay: $945 (602%)
Insurance Median: $401 (255%)
Cash: $945 (602% of Medicare)
Ins. Median: $401 (255% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $156.98 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 255% of the Medicare baseline (a markup of 155%). 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
Medlien Healthcare Services $85 54%
Blue Cross Blue Shield $106 - $878 68%
Clear Springs Eon Health $106 68%
Medicare (plans) $106 - $130 68%
UnitedHealthcare $106 - $308 68%
Va Ccn $106 68%
Humana $107 - $111 68%
Champus Va $108 69%
Tricare $108 69%
Aetna $109 - $299 69%
Coventry $109 - $857 69%
Caresource $110 - $469 70%
Kaiser $110 - $1,096 70%
Wellcare $110 70%
Clover Health $112 71%
Pruitt Health Premier $112 71%
Bccp $117 75%
Fairly Group $122 78%
Us Dept Of Labor Wc $135 86%
Ambetter / Centene $152 - $288 97%
Amerigroup $152 - $179 97%
Medicaid / KanCare $152 - $175 97%
Cbww $154 98%
Truths Community $157 100%
Clarkston Community Health $175 111%
Cigna $181 - $286 115%
East Georgia Cancer Coalition $189 120%
Oscar $237 151%
Good Samaritan Radiology $252 161%
Mti $269 171%
One Call Diagnostics $269 171%
Streamline Imaging $277 176%
Homelink $285 182%
Georgia Reproductive Specialists $504 321%
Med Care Solutions $567 361%
Health One Alliance_Ppo $693 441%
Quick Trip $693 441%
Northside Health Network $781 498%
Novanet_Ppo $882 562%
Phcs $945 602%
Beech Steet $1,071 682%
Multiplan $1,071 682%
Multiplan Workers Comp $1,071 682%
Careiq $1,260 803%
Dekalb_Department Of Health $1,260 803%
Fifa $1,260 803%
Institutional Marietta Surgery Center $1,260 803%
Institutional Veterans Evaluation Services $1,260 803%
Rabun County Boc $1,260 803%

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