Physical therapy (gait training)
Facility: Bluffton Regional Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $113
- Cash Discount Price: $78
- vs. Medicare Baseline: 3.89x 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 389% of the Medicare baseline (a markup of 289%). 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 |
|---|---|---|
| Amish Aid | $18 - $81 | 62% |
| Physicians Health Plan | $18 - $46 | 62% |
| Self Pay | $18 - $185 | 62% |
| Lutheran Preferred Network | $22 - $269 | 76% |
| Theramatrix | $22 | 76% |
| Cigna | $23 - $119 | 79% |
| Php | $23 - $44 | 79% |
| Php Freedom Network | $23 - $56 | 79% |
| UnitedHealthcare | $25 - $186 | 86% |
| Aetna | $26 - $150 | 89% |
| Tricare | $26 | 89% |
| Blue Cross Blue Shield | $27 - $186 | 93% |
| Medicare (plans) | $27 | 93% |
| Node Caresource Mcr Adv | $27 | 93% |
| Node Iu Health Mcr Adv | $27 | 93% |
| Node Mhs Mcr Adv | $27 | 93% |
| Department Of Veterans Affairs | $28 | 96% |
| Humana | $28 - $186 | 96% |
| Node Devoted Health Mcr Adv | $28 | 96% |
| Node Non Par Hospice Agree | $28 | 96% |
| Node Va | $28 | 96% |
| Northeast Hospice | $28 | 96% |
| Php Management Systems | $28 - $130 | 96% |
| Veterans Eval Services | $28 | 96% |
| County Jail Health Care | $29 | 100% |
| In Dept Of Correction | $29 | 100% |
| Lutheran Trma | $29 - $151 | 100% |
| Node Pphp Mcr Adv | $29 | 100% |
| Encore Ppo | $36 - $164 | 124% |
| Sagamore Sebt | $37 - $172 | 127% |
| Sagamore Health Newtork Inc | $39 - $180 | 134% |
| Lutheran Advanced Network | $42 | 145% |
| Lutheran Three Rivers Preferred Plus 150 | $42 | 145% |
| Us Department Of Labor | $43 | 148% |
| Consumer Life | $45 - $208 | 155% |
| Ahg Dana Employees | $47 - $218 | 162% |
| Lutheran Three Rivers Preferred Plus 175 | $49 | 169% |
| Align Networks | $50 - $235 | 172% |
| Encore Work Comp In | $50 | 172% |
| Prime Health Services | $50 - $252 | 172% |
| Private Healthcare Systems Inc | $55 - $252 | 189% |
| Lutheran Northwest Health Preferred | $56 | 193% |
| Managed Health Services Exchange | $56 | 193% |
| Workers Compensation | $56 | 193% |
| Multiplan | $58 - $269 | 200% |
| Encore Health Network | $60 - $302 | 206% |
| Advantage 360 | $61 - $279 | 210% |
| Community Health Alliance | $62 - $286 | 213% |
| First Health | $63 - $289 | 217% |
| Medrisk In Work Comp | $65 | 224% |
| Allied Benefit Systems | $66 - $302 | 227% |
| Cardinal Health Alliance | $66 - $302 | 227% |
| Ppom | $66 - $302 | 227% |
| Encore Kba Epo | $67 | 231% |
| Encore Kba Ppo | $84 | 289% |
| Caresource | $186 | 640% |
| Medicaid / KanCare | $186 | 640% |
| Mhs | $186 | 640% |
| Mhs In Hip | $186 | 640% |