CMS Price Transparency Data

Digestive disorders treatment (inpatient stay)

Facility: Northside Hospital Forsyth

Billing Code: 392 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 392
  • Insurance Median: $5,493
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.97x Medicare
The contracted insurance negotiated median rate for a Digestive disorders treatment (inpatient stay) at Northside Hospital Forsyth is $5,493. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $5,675.87, this hospital’s rate is 0.97x the Medicare baseline. Located in 1200 Northside Forsyth Drive, Cumming, GA.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$5,493

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$5,675.87

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $5,675.87 (100%)
Insurance Median: $5,493 (97%)
Ins. Median: $5,493 (97% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $5,675.87 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.

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
Health One Alliance_Ppo $1,150 20%
Blue Cross Blue Shield $3,245 - $8,589 57%
Kaiser $3,538 - $5,657 62%
Aetna $3,841 - $5,602 68%
Phcs $4,403 78%
Northside Health Network $4,623 81%
UnitedHealthcare $4,634 - $6,354 82%
Clear Springs Eon Health $5,493 97%
Medicare (plans) $5,493 - $6,683 97%
Va Ccn $5,493 97%
Humana $5,547 98%
Coventry $5,602 99%
Cigna $5,657 - $6,294 100%
Wellcare $5,657 100%
Ambetter / Centene $5,767 - $15,254 102%
Caresource $5,767 102%
Clover Health $5,767 102%
Pruitt Health Premier $5,767 102%
Genex/Priority Care Solutions $6,149 108%
Streamline Imaging $6,917 122%
Corvel Workers Comp $7,302 129%
Employers Choice Network $7,302 129%
Georgia Workers Compensation $7,686 135%
One Call Diagnostics $7,686 135%
Us Dept Of Labor Wc $8,771 155%
Georgia Reproductive Specialists $11,752 207%
Amerigroup $14,199 250%
Careiq $29,380 518%
Dekalb_Department Of Health $29,380 518%
Fifa $29,380 518%
Rabun County Boc $29,380 518%
Spreemo $29,380 518%

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