CMS Price Transparency Data

Physical therapy (gait training)

Facility: Uva Health Haymarket Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $56
Cash Discount Price: $59
vs. Medicare Baseline: 1.93x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Uva Health Haymarket Medical Center is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.93x the Medicare baseline. Located in 15225 Healthcote Boulevard, Haymarket, VA.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$56

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: $59 (203%)

Insurance Median: $56 (193%)

Cash: $59 (203% of Medicare)

Ins. Median: $56 (193% 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	$29 - $55	100%
Blue Cross Blue Shield	$29	100%
Champva [50002]	$29	100%
Cigna	$29 - $360	100%
Humana	$29	100%
Medicare (plans)	$29	100%
Tricare	$29	100%
UnitedHealthcare	$29 - $282	100%
VA Ccn [99926]	$29	100%
VA Ccn [99927]	$29	100%
Veterans Administration [99910]	$29	100%
Carefirst [30007]	$54 - $57	186%
Multiplan Generic [40035]	$89	306%
Vhn Generic [40040]	$89	306%
Sentara Behavioral Health [40052]	$91	313%
Sentara [40021]	$91	313%
Kaiser Permenente [40014]	$105	361%
Geha [40009]	$228	785%

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 $59.
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 Uva Health Haymarket Medical Center 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.