CMS Price Transparency Data

Physical therapy (gait training)

Facility: Atrium Health Navicent Peach

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $43
Cash Discount Price: $48
vs. Medicare Baseline: 1.48x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Atrium Health Navicent Peach is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.48x the Medicare baseline. Located in 1960 Highway 247 Connector, Byron, GA.

Cash / Self-Pay

$48

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $48 (165%)

Insurance Median: $43 (148%)

Cash: $48 (165% of Medicare)

Ins. Median: $43 (148% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 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
Aetna	$20 - $57	69%
Blue Cross Blue Shield	$20 - $75	69%
Georgia Health Advantage	$20 - $31	69%
Humana	$20 - $82	69%
Pruitt Health	$20 - $33	69%
UnitedHealthcare	$20 - $60	69%
Care Source	$21 - $32	72%
Clover	$21 - $32	72%
Eon Health	$21 - $32	72%
Ambetter / Centene	$29 - $49	100%
Alliant	$33 - $47	114%
Cigna	$34 - $70	117%
Securehealth	$43 - $62	148%
Multiplan	$62 - $77	213%
Novanet	$77	265%
Three Rivers Provider Network	$82	282%
Beechstreet	$89	306%

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 $48.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97116.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Atrium Health Navicent Peach is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97116.
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.