CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Children's Healthcare of Atlanta at Scottish Rite

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $110
Cash Discount Price: $160
vs. Medicare Baseline: 3.40x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Children's Healthcare of Atlanta at Scottish Rite is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $160. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.40x the Medicare baseline. Located in 1001 Johnson Ferry Road, Atlanta, GA.

Cash / Self-Pay

$160

Average discount available for prompt cash payment at this facility.

Insurance Median

$110

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $160 (494%)

Insurance Median: $110 (340%)

Cash: $160 (494% of Medicare)

Ins. Median: $110 (340% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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 340% of the Medicare baseline (a markup of 240%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Peachstate [43]	$67	207%
Amerigroup [102]	$69	213%
Caresource [61]	$69	213%
Blue Cross Blue Shield	$106 - $156	327%
Cigna	$106	327%
United [5]	$106	327%
Ambetter / Centene	$107	330%
Oscar [228]	$107	330%
Aetna	$108	333%
Caresource Marketplace Bronze/Silver/Gold [60]	$109	336%
Kaiser [6]	$109	336%
Sidecar Health [236]	$110	340%
Coventry [9]	$112	346%
Direct Employer Agreements [72]	$112 - $136	346%
First Health [74]	$120	370%
Northeast Georgia Heatlh System [808]	$120	370%
Veracity Benefits [809]	$120	370%
Phcs [93]	$136	420%
Secure Health [340]	$136	420%
Beech Street [71]	$144	444%
Multiplan [92]	$157	485%
Novanet [41]	$160	494%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $160.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Children's Healthcare of Atlanta at Scottish Rite is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.