CMS Price Transparency Data

Physical therapy (gait training)

Facility: Charleston Area Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $218
Cash Discount Price: $269
vs. Medicare Baseline: 7.50x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Charleston Area Medical Center is $218. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $269. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 7.50x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$269

Average discount available for prompt cash payment at this facility.

Insurance Median

$218

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: $269 (926%)

Insurance Median: $218 (750%)

Cash: $269 (926% of Medicare)

Ins. Median: $218 (750% 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 750% of the Medicare baseline (a markup of 650%). 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
Aetna	$22 - $269	76%
The Health Plan Of West Virginia Inc.	$22 - $266	76%
Unicare Health Plan Of West Virginia Inc.	$22	76%
Optimum Choice Inc.	$24	83%
Blue Cross Blue Shield	$27 - $250	93%
Choicecare Network	$27 - $269	93%
Triwest Va	$27	93%
UnitedHealthcare	$28 - $269	96%
West Virginia Senior Advantage Inc.	$29	100%
Integrated Medical Solutions	$53	182%
Naphcare	$55	189%
Caresource	$69	237%
Tricare	$135 - $164	465%
City Of Charleston	$169 - $206	582%
Cigna	$209 - $255	719%
Three Rivers Providers Network	$218 - $266	750%
Healthsmart	$220 - $269	757%
Multiplan	$220 - $269	757%

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 $269.
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 Charleston Area 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.