CMS Price Transparency Data

Physical therapy (gait training)

Facility: Blount Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $62
Cash Discount Price: $32
vs. Medicare Baseline: 2.13x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Blount Memorial Hospital is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.13x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $32 (110%)

Insurance Median: $62 (213%)

Cash: $32 (110% of Medicare)

Ins. Median: $62 (213% 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 213% of the Medicare baseline (a markup of 113%). 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
Medicaid / KanCare	$16 - $24	55%
UnitedHealthcare	$16 - $190	55%
Prisma Health Seniorcare Pace - Midlands [5400]	$24	83%
Prisma Health Seniorcare Pace-Upstate [5200]	$24	83%
Blue Cross Blue Shield	$28 - $115	96%
Cigna	$28 - $186	96%
Humana	$28	96%
Medicare (plans)	$28	96%
Tricare	$28	96%
Promise Health Plan Contracted [2401]	$36 - $62	124%
Orangeburg Senior Helping Center Pace [5401]	$42	145%
Ambetter / Centene	$43	148%
Consociate Health Contracted [4835]	$61	210%
Bob Jones Univ-Pai [821]	$62	213%
Preferred Administrators Contracted [2839]	$73	251%
Medcost [2940]	$77 - $86	265%
Atlantic Packaging Contracted [4833]	$78	268%
Aps Healthcare System [2981]	$83	286%
Multiplan/Phcs Contracted [2950]	$93	320%
Aetna	$94	323%
Meritain Health Contracted [2200]	$94	323%
Nippon [2300]	$94	323%
Vsp Vision Care [2986]	$94	323%
First Health Contracted [2952]	$97	334%
Furman Int/Allen University Student [2951]	$97	334%
Quiktrip-First Health [3067]	$97	334%
Fairos/Occunet Contracted [4837]	$175	602%
Mvp Health Care [3037]	$186	640%
Golden Rule Insurance Company [2991]	$190	654%
Oxford Health Plans [2992]	$190	654%

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 $32.
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 Blount Memorial 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.