CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Children's Healthcare of Atlanta at Scottish Rite

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $190
Cash Discount Price: $276
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Children's Healthcare of Atlanta at Scottish Rite is $190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $276. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.00x the Medicare baseline. Located in 1001 Johnson Ferry Road, Atlanta, GA.

Cash / Self-Pay

$276

Average discount available for prompt cash payment at this facility.

Insurance Median

$190

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $276 (290%)

Insurance Median: $190 (200%)

Cash: $276 (290% of Medicare)

Ins. Median: $190 (200% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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.

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]	$65 - $196	68%
Amerigroup [102]	$67 - $203	70%
Caresource [61]	$67 - $201	70%
Cigna	$102 - $309	107%
Blue Cross Blue Shield	$103 - $457	108%
United [5]	$103 - $311	108%
Aetna	$104 - $315	109%
Ambetter / Centene	$104 - $313	109%
Oscar [228]	$104 - $314	109%
Caresource Marketplace Bronze/Silver/Gold [60]	$105 - $318	110%
Kaiser [6]	$106 - $319	111%
Sidecar Health [236]	$107 - $323	112%
Direct Employer Agreements [72]	$108 - $398	113%
Coventry [9]	$109 - $328	115%
First Health [74]	$116 - $351	122%
Northeast Georgia Heatlh System [808]	$116 - $351	122%
Veracity Benefits [809]	$116 - $351	122%
Phcs [93]	$132 - $398	139%
Secure Health [340]	$132 - $398	139%
Beech Street [71]	$140 - $421	147%
Multiplan [92]	$152 - $459	160%
Novanet [41]	$155 - $468	163%

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 $276.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 99213.
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.