CMS Price Transparency Data

Psychotherapy session (60 minutes)

Facility: Northside Hospital Forsyth

Billing Code: 90837 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 90837
  • Insurance Median: $384
  • Cash Discount Price: $457
  • vs. Medicare Baseline: 2.12x Medicare
The contracted insurance negotiated median rate for a Psychotherapy session (60 minutes) at Northside Hospital Forsyth is $384. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $457. Compared to the federal Medicare reimbursement reference rate of $181.34, this hospital’s rate is 2.12x the Medicare baseline. Located in 1200 Northside Forsyth Drive, Cumming, GA.
Cash / Self-Pay
$457

Average discount available for prompt cash payment at this facility.

Insurance Median
$384

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$181.34

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $181.34 (100%)
Cash / Self-Pay: $457 (252%)
Insurance Median: $384 (212%)
Cash: $457 (252% of Medicare)
Ins. Median: $384 (212% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $181.34 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 212% of the Medicare baseline (a markup of 112%). 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
Ambetter / Centene $73 - $286 40%
Medicaid / KanCare $73 - $84 40%
Caresource $76 - $227 42%
Amerigroup $87 - $138 48%
Cigna $87 - $384 48%
Champus Va $101 56%
Blue Cross Blue Shield $170 - $424 94%
Clear Springs Eon Health $177 98%
Medicare (plans) $177 - $216 98%
UnitedHealthcare $177 98%
Va Ccn $177 98%
Humana $179 - $184 99%
Bccp $180 99%
Cbww $180 99%
Tricare $180 99%
Truths Community $180 99%
Aetna $181 - $414 100%
Coventry $181 - $414 100%
Kaiser $183 - $530 101%
Wellcare $183 101%
Clover Health $186 103%
Pruitt Health Premier $186 103%
Fairly Group $204 112%
Us Dept Of Labor Wc $225 124%
Georgia Reproductive Specialists $244 135%
Medlien Healthcare Services $244 135%
Mti $257 142%
One Call Diagnostics $257 142%
Homelink $273 151%
Med Care Solutions $274 151%
Oscar $286 158%
Health One Alliance_Ppo $335 185%
Quick Trip $335 185%
Genex/Priority Care Solutions $337 186%
Spreemo $337 186%
Northside Health Network $378 208%
Authentic 4D $379 209%
Streamline Imaging $379 209%
Corvel Workers Comp $400 221%
Employers Choice Network $400 221%
Fieldale Farms Wc $421 232%
Georgia Workers Compensation $421 232%
Novanet_Ppo $426 235%
Phcs $457 252%
Beech Steet $518 286%
Multiplan $518 286%
Multiplan Workers Comp $518 286%
Careiq $609 336%
Dekalb_Department Of Health $609 336%
Fifa $609 336%
Institutional Marietta Surgery Center $609 336%
Institutional Veterans Evaluation Services $609 336%
Rabun County Boc $609 336%

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