CMS Price Transparency Data

Physical therapy (gait training)

Facility: Advanced Surgical Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $29
Cash Discount Price: $28
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Advanced Surgical Hospital is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.00x the Medicare baseline. Located in 100 Trich Drive, Washington, PA.

Cash / Self-Pay

$28

Average discount available for prompt cash payment at this facility.

Insurance Median

$29

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: $28 (96%)

Insurance Median: $29 (100%)

Cash: $28 (96% of Medicare)

Ins. Median: $29 (100% 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
Blue Cross Blue Shield	$26 - $34	89%
Aetna	$28 - $69	96%
Alliance Coal	$28	96%
Amerihealth	$28	96%
Cigna	$28 - $169	96%
Health Plan Of Wv	$28 - $62	96%
Healthamerica	$28 - $33	96%
Medicare (plans)	$28	96%
Pa Health And Wellness	$28	96%
UnitedHealthcare	$28 - $31	96%
Veteran Administration	$28	96%

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 $28.
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 Advanced Surgical 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.