CMS Price Transparency Data

Physical therapy (gait training)

Facility: Atrium Health Navicent Rehabilitation Hopsital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $42
Cash Discount Price: $65
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Atrium Health Navicent Rehabilitation Hopsital is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.45x the Medicare baseline. Located in 3351 Northside Dr, Macon, GA.

Cash / Self-Pay

$65

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: $65 (224%)

Insurance Median: $42 (145%)

Cash: $65 (224% 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
Aetna	$27 - $89	93%
Blue Cross Blue Shield	$27 - $61	93%
Georgia Health Advantage	$27	93%
Humana	$27 - $89	93%
Pruitt Health	$27 - $29	93%
UnitedHealthcare	$27 - $294	93%
Care Source	$28	96%
Clover	$28	96%
Eon Health	$28	96%
Alliant	$33 - $57	114%
Cigna	$34 - $266	117%
Ambetter / Centene	$37 - $66	127%
Ibg	$40 - $91	138%
Securehealth	$43 - $45	148%
Kaiser	$46 - $84	158%
Multiplan	$84 - $103	289%
Novanet	$103	354%
Three Rivers Provider Network	$110	379%
Beechstreet	$120	413%

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 $65.
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 Rehabilitation Hopsital 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.