CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Atrium Health Navicent Rehabilitation Hopsital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $86
Cash Discount Price: $85
vs. Medicare Baseline: 2.96x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Atrium Health Navicent Rehabilitation Hopsital is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.96x the Medicare baseline. Located in 3351 Northside Dr, Macon, GA.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $85 (292%)

Insurance Median: $86 (296%)

Cash: $85 (292% of Medicare)

Ins. Median: $86 (296% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 296% of the Medicare baseline (a markup of 196%). 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
Aetna	$27 - $134	93%
Blue Cross Blue Shield	$27 - $92	93%
Georgia Health Advantage	$27	93%
Humana	$27 - $133	93%
Pruitt Health	$27 - $29	93%
UnitedHealthcare	$27 - $294	93%
Care Source	$28	96%
Clover	$28	96%
Eon Health	$28	96%
Alliant	$33 - $85	114%
Ambetter / Centene	$37 - $99	127%
Cigna	$37 - $266	127%
Ibg	$44 - $137	151%
Kaiser	$50 - $126	172%
Securehealth	$51 - $68	175%
Multiplan	$95 - $155	327%
Novanet	$117 - $155	403%
Three Rivers Provider Network	$124 - $165	427%
Beechstreet	$136 - $180	468%

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 $85.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97110.

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 97110.
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.