CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Atrium Health Navicent Rehabilitation Hopsital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $42
Cash Discount Price: $65
vs. Medicare Baseline: 1.52x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) 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 $27.72, this hospital’s rate is 1.52x 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

$27.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $27.72 (100%)

Cash / Self-Pay: $65 (234%)

Insurance Median: $42 (152%)

Cash: $65 (234% of Medicare)

Ins. Median: $42 (152% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $27.72 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	$26 - $89	94%
Blue Cross Blue Shield	$26 - $61	94%
Care Source	$26	94%
Clover	$26	94%
Eon Health	$26	94%
Georgia Health Advantage	$26	94%
Humana	$26 - $89	94%
Pruitt Health	$26 - $27	94%
UnitedHealthcare	$26 - $294	94%
Alliant	$31 - $57	112%
Ambetter / Centene	$35 - $66	126%
Cigna	$36 - $266	130%
Securehealth	$41 - $45	148%
Ibg	$42 - $91	152%
Kaiser	$49 - $84	177%
Multiplan	$84 - $103	303%
Novanet	$103	372%
Three Rivers Provider Network	$110	397%
Beechstreet	$120	433%

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: 97140.

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 97140.
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.