CMS Price Transparency Data

Ultrasound, leg veins (duplex)

Facility: Northside Hospital Forsyth

Billing Code: 93970 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 93970
  • Insurance Median: $1,340
  • Cash Discount Price: $1,621
  • vs. Medicare Baseline: 5.50x Medicare
The contracted insurance negotiated median rate for a Ultrasound, leg veins (duplex) at Northside Hospital Forsyth is $1,340. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,621. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.50x the Medicare baseline. Located in 1200 Northside Forsyth Drive, Cumming, GA.
Cash / Self-Pay
$1,621

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,340

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)
Cash / Self-Pay: $1,621 (665%)
Insurance Median: $1,340 (550%)
Cash: $1,621 (665% of Medicare)
Ins. Median: $1,340 (550% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 550% of the Medicare baseline (a markup of 450%). 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 $148 61%
Med Care Solutions $200 82%
Truths Community $237 97%
Blue Cross Blue Shield $238 - $1,506 98%
Clear Springs Eon Health $238 98%
Medicare (plans) $238 - $291 98%
UnitedHealthcare $238 - $1,528 98%
Va Ccn $238 98%
Humana $241 - $248 99%
Bccp $242 99%
Cbww $242 99%
Tricare $242 99%
Aetna $243 - $1,469 100%
Coventry $243 - $1,469 100%
Caresource $246 - $804 101%
Kaiser $246 - $1,880 101%
Mti $246 101%
One Call Diagnostics $246 101%
Wellcare $246 101%
Clover Health $250 103%
Pruitt Health Premier $250 103%
Ambetter / Centene $260 - $1,016 107%
Amerigroup $260 - $307 107%
Medicaid / KanCare $260 - $299 107%
Homelink $262 107%
Fairly Group $274 112%
Us Dept Of Labor Wc $303 124%
Cigna $310 - $1,361 127%
Genex/Priority Care Solutions $507 208%
Spreemo $507 208%
Authentic 4D $570 234%
Streamline Imaging $570 234%
Corvel Workers Comp $602 247%
Employers Choice Network $602 247%
Fieldale Farms Wc $633 260%
Georgia Workers Compensation $633 260%
Georgia Reproductive Specialists $864 354%
Medlien Healthcare Services $864 354%
Oscar $1,016 417%
Health One Alliance_Ppo $1,189 488%
Quick Trip $1,189 488%
Northside Health Network $1,340 550%
Novanet_Ppo $1,513 621%
Phcs $1,621 665%
Beech Steet $1,837 754%
Multiplan $1,837 754%
Multiplan Workers Comp $1,837 754%
Careiq $2,161 886%
Dekalb_Department Of Health $2,161 886%
Fifa $2,161 886%
Institutional Marietta Surgery Center $2,161 886%
Institutional Veterans Evaluation Services $2,161 886%
Rabun County Boc $2,161 886%

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