CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: Northside Hospital Duluth

Billing Code: 99203 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$141

about 1.2× the $118 Medicare rate · typically $80–$286

modeled estimate · not a bill or quote

What this hospital charges insurers

$105

Below the fair price — a good deal

about $36 under the fair price · 0.9× Medicare

Medicare pays $118 Fair price $141 This hospital $105 Cash price $254 Hospital's list price $339

How we calculate the fair BaseRate →

How this hospital compares to other GA hospitals

Highest price of the 9 GA hospitals we have prices for — worth calling around.

Cheapest $57 Priciest $105

Black dot = this hospital, among the 9 GA hospitals with a price for this procedure. Full list below.

A fair price for a New patient office visit (30-44 min) is about $141 (about 1.2× the $118 Medicare rate). Northside Hospital Duluth charges insurers about $105, or about $254 in cash — below the fair price — a good deal. Located in Duluth, GA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$73 - $230	62%
Blue Cross Blue Shieldmajor	$73 - $236	62%
Aetnamajor	$73 - $231	62%
Cignamajor	$51 - $214	43%
Humanamajor	$73	62%
Kaiser Permanentemajor	$73 - $295	62%
Ambetter (Centene)	$43 - $159	37%
Amerigroup	$43 - $77	37%
CareSource	$44 - $126	37%
Clover Health	$77	65%
Health Net	$97 - $210	83%
Oscar Health	$98 - $159	83%
WellCare	$73	62%
+ 19 smaller / regional plans	$43 - $339

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 254), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 99203.

Insurance Before you use insurance

Call your insurance company to confirm Northside Hospital Duluth is in-network.
Ask your insurer whether prior approval is required for CPT code 99203.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Northside Hospital Duluth

Compare: New patient office visit (30-44 min) at other GA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.