CMS Price Transparency Data

Physical therapy (gait training)

Facility: Vidant Chowan Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $120
Cash Discount Price: $106
vs. Medicare Baseline: 4.13x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Vidant Chowan Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.13x the Medicare baseline. Located in 211 Virginia Rd, Edenton, NC.

Cash / Self-Pay

$106

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $106 (365%)

Insurance Median: $120 (413%)

Cash: $106 (365% of Medicare)

Ins. Median: $120 (413% 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 413% of the Medicare baseline (a markup of 313%). 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
Blue Cross Blue Shield	$57 - $115	196%
Wellcare [1320]	$58	200%
Amerihealth McAid Adv [1316]	$58	200%
Carolina Complete Health [1317]	$58	200%
Humana	$59	203%
UnitedHealthcare	$64 - $117	220%
Liberty Advantage [1313]	$66	227%
Aetna	$68 - $155	234%
Longevity Health [1411]	$82	282%
Nc Dept of Public Safety [1095]	$106	365%
Medcost [1067]	$120 - $127	413%
Cigna	$162 - $180	557%
Multiplan [1031]	$180	619%

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 $106.
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 Vidant Chowan 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.