CMS Price Transparency Data

Physical therapy (gait training)

Facility: Dickenson Community Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $42
Cash Discount Price: $27
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Dickenson Community Hospital is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $27. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.45x the Medicare baseline. Located in 312 Hospital Drive, Clintwood, VA.

Cash / Self-Pay

$27

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

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: $27 (93%)

Insurance Median: $42 (145%)

Cash: $27 (93% of Medicare)

Ins. Median: $42 (145% 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	$29 - $116	100%
Aetna	$35 - $94	120%
Amerigroup	$35	120%
Managed Medicaire	$35	120%
Medicare (plans)	$35	120%
Sentara Health	$35 - $43	120%
United Mine Workers Of America	$35	120%
UnitedHealthcare	$35 - $117	120%
Humana	$36	124%
Molina Healthcare	$36 - $53	124%
Cigna	$37 - $57	127%
Devoted Health Plan	$37	127%
Nhc Advantage	$37	127%
Medcost	$41	141%
Ambetter / Centene	$43	148%
Optima Health	$51	175%
Seven Corners, Inc.	$117	403%

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 $27.
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 Dickenson Community 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.