CMS Price Transparency Data

Physical therapy (gait training)

Facility: University of Iowa Health Care Medical Center Down

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $132
Cash Discount Price: $133
vs. Medicare Baseline: 4.54x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at University of Iowa Health Care Medical Center Down is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.54x the Medicare baseline. Located in 500 E Market Street, Iowa City, IA.

Cash / Self-Pay

$133

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

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: $133 (458%)

Insurance Median: $132 (454%)

Cash: $133 (458% of Medicare)

Ins. Median: $132 (454% 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 454% of the Medicare baseline (a markup of 354%). 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
Iowa Total Care	$22	76%
Molina Healthcare	$22	76%
Wellpoint (Amerigroup)	$22	76%
Aetna	$27 - $225	93%
Immergrun	$39 - $56	134%
UnitedHealthcare	$59 - $169	203%
Blue Cross Blue Shield	$75 - $107	258%
Healthpartners	$78 - $190	268%
Medical Associates	$78 - $149	268%
Quad City Community Healthcare	$78 - $167	268%
Midlands Choice	$82 - $145	282%
Oscar Health	$98 - $140	337%
Great River Health Systems	$109 - $156	375%
Aplos Health Plan	$125 - $178	430%
Sedgwick	$125 - $178	430%
Global Excel	$133 - $190	458%
Sanford Health Plan	$133 - $190	458%
Sisco	$137 - $196	471%
Employee Benefit Systems	$140 - $201	482%
Healthsmart	$140 - $201	482%
Hfn	$144 - $205	496%
Multiplan	$144 - $205	496%

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 $133.
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 University of Iowa Health Care Medical Center Down 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.