CMS Price Transparency Data

Physical therapy (gait training)

Facility: Memorial Mission Hospital and Asheville Surgery Ce

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $30
Cash Discount Price: $154
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Memorial Mission Hospital and Asheville Surgery Ce is $30. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.03x the Medicare baseline. Located in 509 Biltmore Ave, Asheville, NC.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$30

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: $154 (530%)

Insurance Median: $30 (103%)

Cash: $154 (530% of Medicare)

Ins. Median: $30 (103% 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.

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	$25 - $112	86%
Alignment Health	$25 - $28	86%
Humana	$25 - $29	86%
United	$25 - $91	86%
United Behavioral Health	$25 - $28	86%
Wellcare	$25 - $29	86%
Provider Partners Health Plan	$26 - $30	89%
Pruitthealth Premier	$26 - $29	89%
Cigna	$27 - $77	93%
Healthteam Advantage	$27 - $31	93%
Troy Healthcare	$27 - $30	93%
Amerihealth Caritas	$28 - $73	96%
Blue Cross Blue Shield	$28	96%
Amerihealth	$29	100%
Longevity Health Plan	$30 - $34	103%
Partners Health Management	$30	103%
Vaya Health	$30	103%
Apex Health	$31	107%
Oscar	$55	189%
Caresource	$68	234%
Medcost	$87 - $131	299%
Magellan	$93	320%
Magellan Behavioral Health	$93	320%
Multiplan	$123	423%
Avalon Administrative Services	$131	451%
Prime Health	$136 - $139	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 $154.
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 Memorial Mission Hospital and Asheville Surgery Ce 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.