CMS Price Transparency Data

Ultrasound, thyroid and neck

Facility: Northside Hospital Forsyth

Billing Code: 76536 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 76536
  • Insurance Median: $285
  • Cash Discount Price: $863
  • vs. Medicare Baseline: 2.67x Medicare
The contracted insurance negotiated median rate for a Ultrasound, thyroid and neck at Northside Hospital Forsyth is $285. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $863. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 2.67x the Medicare baseline. Located in 1200 Northside Forsyth Drive, Cumming, GA.
Cash / Self-Pay
$863

Average discount available for prompt cash payment at this facility.

Insurance Median
$285

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)
Cash / Self-Pay: $863 (808%)
Insurance Median: $285 (267%)
Cash: $863 (808% of Medicare)
Ins. Median: $285 (267% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 267% of the Medicare baseline (a markup of 167%). 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 $80 75%
Blue Cross Blue Shield $104 - $802 97%
Clear Springs Eon Health $104 97%
Medicare (plans) $104 - $127 97%
UnitedHealthcare $104 - $596 97%
Va Ccn $104 97%
Bccp $106 99%
Cbww $106 99%
Humana $106 - $109 99%
Tricare $106 99%
Aetna $107 - $782 100%
Coventry $107 - $782 100%
Caresource $108 - $428 101%
Kaiser $108 - $331 101%
Wellcare $108 101%
Clarkston Community Health $110 103%
Clover Health $110 103%
Pruitt Health Premier $110 103%
Fairly Group $120 112%
Us Dept Of Labor Wc $133 125%
Ambetter / Centene $139 - $482 130%
Amerigroup $139 - $164 130%
Medicaid / KanCare $139 - $159 130%
Cigna $165 - $724 154%
Oscar $191 179%
Mti $199 186%
One Call Diagnostics $199 186%
Med Care Solutions $200 187%
Medlien Healthcare Services $200 187%
Homelink $211 198%
Streamline Imaging $216 202%
Genex/Priority Care Solutions $223 209%
Spreemo $223 209%
Good Samaritan Radiology $230 215%
Truths Community $237 222%
Authentic 4D $251 235%
Direct Pay Provider Network Llc $251 235%
Corvel Workers Comp $265 248%
Employers Choice Network $265 248%
Fieldale Farms Wc $279 261%
Georgia Workers Compensation $279 261%
Northside Health Network $455 426%
Georgia Reproductive Specialists $460 431%
Health One Alliance_Ppo $632 592%
Quick Trip $632 592%
Novanet_Ppo $805 754%
Phcs $862 807%
Beech Steet $978 916%
Multiplan $978 916%
Multiplan Workers Comp $978 916%
Careiq $1,150 1077%
Dekalb_Department Of Health $1,150 1077%
Fifa $1,150 1077%
Institutional Marietta Surgery Center $1,150 1077%
Institutional Veterans Evaluation Services $1,150 1077%
Rabun County Boc $1,150 1077%

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