CMS Price Transparency Data

Physical therapy (gait training)

Facility: Novant Health Medical Park Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $85
Cash Discount Price: $74
vs. Medicare Baseline: 2.92x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Novant Health Medical Park Hospital is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.92x the Medicare baseline. Located in 1950 S Hawthorne Rd, Winston-Salem, NC.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

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: $74 (255%)

Insurance Median: $85 (292%)

Cash: $74 (255% of Medicare)

Ins. Median: $85 (292% 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 292% of the Medicare baseline (a markup of 192%). 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
Carolina Complete	$29	100%
Nc Department Of Public Safety	$29	100%
Amerihealth	$30	103%
Blue Cross Blue Shield	$30 - $89	103%
UnitedHealthcare	$30 - $83	103%
Wellcare	$30	103%
Cigna	$48 - $73	165%
Caresource North Carolina	$49	169%
Aetna	$62 - $98	213%
Atlantic Corporation Dba Atlantic Packaging	$69	237%
Plotkin Health	$74	255%
Amps	$80	275%
Humana	$96	330%
Medcost	$105 - $116	361%
Primary Physician Care	$108	372%
Beechstreet	$111	382%
Multiplan	$111	382%
Phcs	$111	382%
Employers Choice Network	$119	409%
Three Rivers Provider Network	$119	409%

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 $74.
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 Novant Health Medical Park Hospital 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.