CMS Price Transparency Data

Physical therapy (gait training)

Facility: Ochsner Choctaw General

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $52
Cash Discount Price: $117
vs. Medicare Baseline: 1.79x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Ochsner Choctaw General is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.79x the Medicare baseline. Located in 401 Vanity Fair Lane, Po Box 618, Butler, AL.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $117 (403%)

Insurance Median: $52 (179%)

Cash: $117 (403% of Medicare)

Ins. Median: $52 (179% 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	$22 - $69	76%
Medicaid / KanCare	$24 - $27	83%
Blue Cross Blue Shield	$25 - $100	86%
UnitedHealthcare	$26 - $110	89%
Cigna	$27 - $75	93%
Magnolia Health Plan – Wellcare By All Well Of Mississippi	$27 - $69	93%
Medicare (plans)	$27 - $80	93%
Shared Health Mississippi	$28 - $73	96%
Claritev D/B/A Multiplan/Phcs/American Life Care	$30 - $116	103%
Prime Health Services Ppo	$31 - $123	107%
Select Administrative Services Network	$34 - $108	117%
Aetna	$37 - $100	127%
Primewell Health Services Commercial Exchange Plan	$43 - $103	148%
Primewell Health Services – Commercial	$43 - $103	148%
Prime Health Services Ppo -Workers Comp	$51 - $123	175%
Cor Vel	$52 - $126	179%
Zelis	$52 - $116	179%
Ambetter / Centene	$70	241%

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 $117.
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 Ochsner Choctaw General 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.