CMS Price Transparency Data

Physical therapy (gait training)

Facility: Nemours Children's Hospital, Delaware

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $112
Cash Discount Price: $197
vs. Medicare Baseline: 3.85x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Nemours Children's Hospital, Delaware is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $197. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.85x the Medicare baseline. Located in 1600 Rockland Rd Po Box 269, Wilmington, DE.

Cash / Self-Pay

$197

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $197 (678%)

Insurance Median: $112 (385%)

Cash: $197 (678% of Medicare)

Ins. Median: $112 (385% 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 385% of the Medicare baseline (a markup of 285%). 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
Tricare	$29	100%
Us Family Health Plan	$32	110%
Keystone First Hlth Plan	$39 - $87	134%
Celtic Transplant	$49 - $197	169%
Celtic Transplant For De First Health	$69	237%
UnitedHealthcare	$72 - $123	248%
Wellpoint Maryland	$73	251%
Kidz Partners	$75	258%
Health Partners	$76	262%
Upmc	$78	268%
Fidelis	$79	272%
Aetna	$84 - $114	289%
Blue Cross Blue Shield	$87 - $174	299%
Priority Partners John Hopkins	$97	334%
Six Degrees Health Transplant	$98	337%
Cigna	$108 - $124	372%
Great West-One Health Plan	$108 - $124	372%
Ambetter / Centene	$112	385%
Amerihealth Caritas Delaware	$112	385%
Geisinger Health Plan	$118	406%
Integra Administrative Group	$118	406%
National Transplant Network (Ntn)	$128	440%
Six Degrees Health	$128	440%
Star Healthcare Network	$128	440%
Life Trac Solid Organ And Bmt Transplant	$138	475%
First Health Network	$187	643%
Insurance Administrators Of America	$187	643%
Interlink Transplant Network	$187	643%
Multiplan	$187	643%
Preferred Healthcare	$187	643%
Private Healthcare Systems	$187	643%
Three Rivers Provider Network	$187	643%
Carefirst Md Community Health Plan	$201	692%

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 $197.
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 Nemours Children's Hospital, Delaware 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.