CMS Price Transparency Data

Physical therapy (gait training)

Facility: UPMC St Margaret

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $44
Cash Discount Price: $66
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at UPMC St Margaret is $44. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.51x the Medicare baseline. Located in 815 Freeport Road, Pittsburgh, PA.

Cash / Self-Pay

$66

Average discount available for prompt cash payment at this facility.

Insurance Median

$44

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: $66 (227%)

Insurance Median: $44 (151%)

Cash: $66 (227% of Medicare)

Ins. Median: $44 (151% 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
UnitedHealthcare	$9	31%
Upmc Health Plan	$9 - $85	31%
Highmark Wholecare (Prev Gateway)	$12 - $55	41%
Amerihealth Caritas	$13	45%
Pa Health & Wellness	$14	48%
Blue Cross Blue Shield	$26 - $120	89%
Aetna	$28 - $44	96%
Cigna	$31 - $44	107%
Upmc Work Partners	$38	131%
Coventry/First Health	$77	265%
Private Health Care Systems	$88	303%
Selectcare	$88	303%
Humana	$94	323%

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 $66.
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 UPMC St Margaret 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.