CMS Price Transparency Data

Sepsis treatment (inpatient stay)

Facility: Northside Hospital Forsyth

Billing Code: 871 (MS-DRG)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 871
  • Insurance Median: $6,294
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.45x Medicare
The contracted insurance negotiated median rate for a Sepsis treatment (inpatient stay) at Northside Hospital Forsyth is $6,294. 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 $14,116.91, this hospital’s rate is 0.45x 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
$6,294

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$14,116.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $14,116.91 (100%)
Insurance Median: $6,294 (45%)
Ins. Median: $6,294 (45% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $14,116.91 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
Blue Cross Blue Shield $3,245 - $13,634 23%
Kaiser $3,538 - $14,043 25%
Aetna $3,841 - $13,906 27%
Phcs $4,403 31%
Northside Health Network $4,623 33%
UnitedHealthcare $4,634 - $13,634 33%
Cigna $6,294 - $14,043 45%
Clear Springs Eon Health $13,634 97%
Medicare (plans) $13,634 - $16,652 97%
Va Ccn $13,634 97%
Humana $13,770 98%
Coventry $13,906 99%
Wellcare $14,043 99%
Ambetter / Centene $14,315 - $37,314 101%
Caresource $14,315 101%
Clover Health $14,315 101%
Pruitt Health Premier $14,315 101%
Genex/Priority Care Solutions $15,461 110%
Streamline Imaging $17,394 123%
Corvel Workers Comp $18,360 130%
Employers Choice Network $18,360 130%
Georgia Workers Compensation $19,327 137%
One Call Diagnostics $19,327 137%
Us Dept Of Labor Wc $19,820 140%
Amerigroup $22,991 163%
Georgia Reproductive Specialists $25,155 178%
Careiq $62,888 445%
Dekalb_Department Of Health $62,888 445%
Fifa $62,888 445%
Rabun County Boc $62,888 445%
Spreemo $62,888 445%

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