Physical therapy (gait training)
Facility: Johnson Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $102
- Cash Discount Price: $86
- vs. Medicare Baseline: 3.51x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 351% of the Medicare baseline (a markup of 251%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $30 - $122 | 103% |
| Blue Cross Blue Shield | $30 - $101 | 103% |
| UnitedHealthcare | $30 - $369 | 103% |
| Medicare (plans) | $30 - $32 | 103% |
| Cigna | $31 - $143 | 107% |
| Cca Senior Care Options | $31 | 107% |
| Fallon Health | $40 | 138% |
| Connecticut Dept of Correction | $53 | 182% |
| Innovative Health Plan II | $64 | 220% |
| Claimdoc | $64 | 220% |
| Diversified Administrators | $64 | 220% |
| Centivo | $71 | 244% |
| Blue Distinction Transplant | $101 | 348% |
| Kaiser Domestic | $101 | 348% |
| Wc Domestic | $101 | 348% |
| Blue Benefit Administrators of Massachusetts | $101 | 348% |
| Blue Shield - Wa (Regence) | $101 | 348% |
| Blue Shield - Ny Highmark Western | $101 | 348% |
| Wellpoint | $101 | 348% |
| Blue Shield - PA (Highmark) | $101 | 348% |
| Blue Shield - Ny Highmark Northeastern | $101 | 348% |
| Blue Care Network | $101 | 348% |
| Bcn Domestic | $101 | 348% |
| Blue Shield - Id (Regence) | $101 | 348% |
| Unicare | $101 | 348% |
| Pre-Employment | $101 | 348% |
| Health Choices | $101 | 348% |
| Blue Shield - Ca | $101 | 348% |
| Health New England | $102 | 351% |
| Allied Benefit Systems | $122 | 420% |
| Gravie Admin Services | $122 | 420% |
| Webtpa | $122 | 420% |
| Nippon Life Ins | $122 | 420% |
| Luminare Health | $122 | 420% |
| 1199 National Benefit Fund | $122 | 420% |
| Hap | $122 | 420% |
| Meritain | $122 | 420% |
| Prime Health Services | $126 | 434% |
| Family Life Insurance Company | $130 | 447% |
| Medi Share | $130 | 447% |
| Pan-American Life | $130 | 447% |
| Manhattan Life | $130 | 447% |
| Lifetime Benefit Solutions | $130 | 447% |
| Paramount HMO | $130 | 447% |
| Allied National Global Care | $130 | 447% |
| Pai | $130 | 447% |
| Ghc Scw | $130 | 447% |
| Multiplan | $130 | 447% |
| Trinity Health Share | $130 | 447% |
| Mvp | $130 | 447% |
| International Benefit Administrators | $130 | 447% |
| Christian Care Ministry | $130 | 447% |
| PHCS | $130 | 447% |
| Dean Health | $130 | 447% |
| Asrm - Reliance Standard Life Insurance | $130 | 447% |
| Health Smart | $133 | 458% |
| Magnacare | $143 | 492% |
| Allegiance | $143 | 492% |
| Health Partners | $143 | 492% |
| United Behavioral Health Eap | $157 | 540% |
| Connecticare | $242 - $314 | 833% |
| Harvard Pilgrim Healthcare | $369 | 1270% |
| Geha | $369 | 1270% |