CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Northside Hospital Forsyth

Billing Code: 97535 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$43

about 1.3× the $32 Medicare rate · typically $32–$68

modeled estimate · not a bill or quote

What this hospital charges insurers

$48

About the fair price

about $5 over the fair price · 1.5× Medicare

Medicare pays $32 Fair price $43 This hospital $48 Cash price $205 Hospital's list price $273

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 $11 Priciest $48

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

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Occupational therapy (self-care training) is about $43 (about 1.3× the $32 Medicare rate). Northside Hospital Forsyth charges insurers about $48, or about $205 in cash — about the fair price. Located in Cumming, 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	$32 - $175	99%
Blue Cross Blue Shieldmajor	$32 - $190	99%
Aetnamajor	$32 - $186	99%
Cignamajor	$39 - $172	120%
Humanamajor	$32 - $33	99%
Kaiser Permanentemajor	$32 - $238	99%
Ambetter (Centene)	$33 - $128	102%
Amerigroup	$33 - $39	102%
CareSource	$32 - $102	99%
Clover Health	$33	102%
Health Net	$169	522%
Oscar Health	$128	395%
WellCare	$32	99%
+ 18 smaller / regional plans	$32 - $273

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 205), 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: 97535.

Insurance Before you use insurance

Call your insurance company to confirm Northside Hospital Forsyth is in-network.
Ask your insurer whether prior approval is required for CPT code 97535.
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 Forsyth

Compare: Occupational therapy (self-care training) at other GA hospitals

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