CMS Price Transparency Data

Physical therapy (gait training)

Facility: Atrium Health Anson

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $77
Cash Discount Price: $83
vs. Medicare Baseline: 2.65x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Atrium Health Anson is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.65x the Medicare baseline. Located in 2301 Us Highway 74 West, Wadesboro, NC.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $83 (286%)

Insurance Median: $77 (265%)

Cash: $83 (286% of Medicare)

Ins. Median: $77 (265% 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 265% of the Medicare baseline (a markup of 165%). 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
Alliance	$20 - $26	69%
Amerihealth Caritas	$20 - $25	69%
Carolina Complete Health	$20 - $25	69%
Healthy Blue	$20 - $25	69%
Partners	$20 - $25	69%
Trillium	$20 - $26	69%
UnitedHealthcare	$20 - $129	69%
Vaya	$20 - $26	69%
Wellcare	$20 - $25	69%
Cigna	$28 - $112	96%
Humana	$28	96%
Aetna	$29 - $150	100%
Ambetter / Centene	$51 - $62	175%
Blue Cross Blue Shield	$67 - $104	231%
Employers Health Network	$74	255%
Physician Reach Out	$83	286%
Medcost	$99 - $156	341%
Gmmi	$108	372%
Quik Trip	$108	372%
Choicecare	$150	516%
First Health	$150	516%
Healthgram	$150	516%
Provider Select	$150	516%
Private Health Care Systems	$153	526%
Beechstreet	$158	544%
Multiplan	$158	544%

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 $83.
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 Anson 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.