CMS Price Transparency Data

Physical therapy (gait training)

Facility: Boone Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $20
Cash Discount Price: $35
vs. Medicare Baseline: 0.69x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Boone Memorial Hospital is $20. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 0.69x the Medicare baseline. Located in 701 Madison Avenue, Madison, WV.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$20

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: $35 (120%)

Insurance Median: $20 (69%)

Cash: $35 (120% of Medicare)

Ins. Median: $20 (69% 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
Humana	$19	65%
Medicare (plans)	$19 - $27	65%
Aetna	$20 - $66	69%
Blue Cross Blue Shield	$20	69%
Medicaid / KanCare	$21	72%
Cigna	$52	179%

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 $35.
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 Boone 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.