CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Children's Healthcare of Atlanta at Scottish Rite

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $252
Cash Discount Price: $415
vs. Medicare Baseline: 1.86x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Children's Healthcare of Atlanta at Scottish Rite is $252. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $415. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 1.86x the Medicare baseline. Located in 1001 Johnson Ferry Road, Atlanta, GA.

Cash / Self-Pay

$415

Average discount available for prompt cash payment at this facility.

Insurance Median

$252

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $415 (306%)

Insurance Median: $252 (186%)

Cash: $415 (306% of Medicare)

Ins. Median: $252 (186% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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]	$94 - $244	69%
Caresource [61]	$96 - $251	71%
Amerigroup [102]	$97 - $253	72%
Cigna	$148 - $386	109%
Blue Cross Blue Shield	$149 - $570	110%
United [5]	$149 - $387	110%
Ambetter / Centene	$150 - $391	111%
Oscar [228]	$150 - $391	111%
Aetna	$151 - $393	111%
Caresource Marketplace Bronze/Silver/Gold [60]	$152 - $397	112%
Kaiser [6]	$153 - $398	113%
Sidecar Health [236]	$155 - $403	114%
Coventry [9]	$157 - $410	116%
Direct Employer Agreements [72]	$157 - $496	116%
First Health [74]	$168 - $438	124%
Northeast Georgia Heatlh System [808]	$168 - $438	124%
Veracity Benefits [809]	$168 - $438	124%
Phcs [93]	$190 - $496	140%
Secure Health [340]	$190 - $496	140%
Beech Street [71]	$202 - $526	149%
Multiplan [92]	$220 - $572	162%
Novanet [41]	$224 - $584	165%

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 $415.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.