CMS Price Transparency Data

Physical therapy (gait training)

Facility: St Marys Good Samaritan Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $42
Cash Discount Price: $81
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at St Marys Good Samaritan Hospital is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $81. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.45x the Medicare baseline. Located in 5401 Lake Oconee Parkway, Greensboro, GA.

Cash / Self-Pay

$81

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

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: $81 (279%)

Insurance Median: $42 (145%)

Cash: $81 (279% of Medicare)

Ins. Median: $42 (145% 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
Blue Cross Blue Shield	$24 - $90	83%
Aetna	$33 - $99	114%
Ambetter / Centene	$33	114%
Care Improvement Plus	$33	114%
Caresource	$33	114%
Cigna	$33 - $102	114%
Coventry	$33 - $93	114%
Eon Health Plan	$33	114%
Humana	$33 - $93	114%
Kaiser Permanente	$33	114%
Molina	$33	114%
Pruitthealth Premier	$33	114%
Todays Options Pffs	$33	114%
Todays Options Ppo	$33	114%
UnitedHealthcare	$33 - $2,632	114%
Vaccn United	$33	114%
Wellcare	$33	114%
First Health	$93	320%
Phcs	$93	320%
Meritain	$99	341%
Multiplan	$105 - $108	361%
Nova	$105 - $112	361%
Three Rivers Provider Network	$112	385%
Amerigroup	$124	427%

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 $81.
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 St Marys Good Samaritan Hospital 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.