CMS Price Transparency Data

Physical therapy (gait training)

Facility: Carolina East Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $70
Cash Discount Price: $57
vs. Medicare Baseline: 2.41x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Carolina East Medical Center is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.41x the Medicare baseline. Located in 2000 Neuse Blvd, New Bern, NC.

Cash / Self-Pay

$57

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $57 (196%)

Insurance Median: $70 (241%)

Cash: $57 (196% of Medicare)

Ins. Median: $70 (241% 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 241% of the Medicare baseline (a markup of 141%). 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
Pamlico Co Jail-All Plans	$21 - $30	72%
UnitedHealthcare	$27 - $80	93%
Humana	$28	96%
Inclusive Health (Nchirp)-All Plans	$28	96%
Tricare	$28 - $113	96%
Craven Co. Jail Systems - All Plans	$38 - $40	131%
Medcost Ppo Employees And Retirees	$51 - $74	175%
Medcost Ppo Ultra (Employees)	$51 - $71	175%
Blue Cross Blue Shield	$54 - $78	186%
Medcost Ppo City Employees	$57 - $82	196%
Medcost Ppo County Employee	$59 - $86	203%
Benefit Mgmt, Svcs-All Plans	$66 - $96	227%
Aetna	$69 - $100	237%
Medcost Benefit Svc-All Other Plans	$69 - $100	237%
Acs Consult Svc Inc-All Plans	$70 - $102	241%
Medcost Ppo Standard	$70 - $102	241%
Cigna	$71 - $103	244%

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 $57.
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 Carolina East Medical Center 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.