CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Children's Healthcare of Atlanta at Scottish Rite

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $110
Cash Discount Price: $160
vs. Medicare Baseline: 3.36x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) 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 $32.73, this hospital’s rate is 3.36x 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

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $160 (489%)

Insurance Median: $110 (336%)

Cash: $160 (489% of Medicare)

Ins. Median: $110 (336% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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 336% of the Medicare baseline (a markup of 236%). 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	205%
Amerigroup [102]	$69	211%
Caresource [61]	$69	211%
Blue Cross Blue Shield	$106 - $156	324%
Cigna	$106	324%
United [5]	$106	324%
Ambetter / Centene	$107	327%
Oscar [228]	$107	327%
Aetna	$108	330%
Caresource Marketplace Bronze/Silver/Gold [60]	$109	333%
Kaiser [6]	$109	333%
Sidecar Health [236]	$110	336%
Coventry [9]	$112	342%
Direct Employer Agreements [72]	$112 - $136	342%
First Health [74]	$120	367%
Northeast Georgia Heatlh System [808]	$120	367%
Veracity Benefits [809]	$120	367%
Phcs [93]	$136	416%
Secure Health [340]	$136	416%
Beech Street [71]	$144	440%
Multiplan [92]	$157	480%
Novanet [41]	$160	489%

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: 97112.

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 97112.
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.