Physical therapy (gait training)
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $113
- Cash Discount Price: $113
- 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 |
|---|---|---|
| Aetna | $16 - $113 | 55% |
| Blue Cross Blue Shield | $16 - $186 | 55% |
| Medicaid / KanCare | $16 - $186 | 55% |
| UnitedHealthcare | $16 - $186 | 55% |
| Medicare (plans) | $28 - $29 | 96% |
| Meridian Complete | $28 | 96% |
| Pace-Trinity Health | $28 | 96% |
| County Coroner | $29 | 100% |
| Provider Partners Health Plan Of Indiana | $31 | 107% |
| Auxiant | $42 - $144 | 145% |
| Physicians Health Plan Northern Indiana Health Insurance | $42 - $85 | 145% |
| St Joseph County Hlth Dpt | $42 | 145% |
| Caresource | $43 | 148% |
| Siho Insurance Services | $45 | 155% |
| Plain Church Group | $47 | 162% |
| Key Benefit Administrator | $50 - $122 | 172% |
| Allied Benefit Systems | $53 - $113 | 182% |
| Blue Benefit Administrators Of Massachusetts | $56 | 193% |
| Blue Care Network | $56 | 193% |
| Blue Distinction Transplant | $56 | 193% |
| Blue Shield - Ca | $56 | 193% |
| Blue Shield - Id (Regence) | $56 | 193% |
| Blue Shield - Ny Highmark Northeastern | $56 | 193% |
| Blue Shield - Ny Highmark Western | $56 | 193% |
| Blue Shield - Pa (Highmark) | $56 | 193% |
| Blue Shield - Wa (Regence) | $56 | 193% |
| Custom Design Benefits | $60 | 206% |
| Notre Dame Athletic Association | $96 | 330% |
| Wc Notre Dame | $96 | 330% |
| Luminare Health (Detroit) | $99 - $104 | 341% |
| Ameriben | $104 | 358% |
| Geha | $111 | 382% |
| Healthscope | $111 | 382% |
| Student Insurance Cma | $111 | 382% |
| Asr Health Benefits | $113 | 389% |
| Christian Brother Services | $113 | 389% |
| Employee Benefit Management | $113 | 389% |
| Medical Mutual | $113 | 389% |
| Meritain | $113 | 389% |
| Preferred One | $113 | 389% |
| Rural Carrier Health Benefit Plan | $113 | 389% |
| Webtpa | $113 | 389% |
| Encore Health | $122 | 420% |
| Indiana Criminal Justice Inst | $122 | 420% |
| Western & Southern Financial Group | $122 | 420% |
| Cigna | $125 | 430% |
| Group Administrators | $125 | 430% |
| Health Partners | $125 | 430% |
| Mvp | $125 | 430% |
| Prairie States | $125 | 430% |
| Priority Health | $125 | 430% |
| Professional Benefit Administrators | $125 | 430% |
| Sagamore Health Network | $125 - $134 | 430% |
| Sisco Benefits | $125 | 430% |
| Unified Group Services | $125 | 430% |
| Goshen Preferred Network | $134 - $150 | 461% |
| Signature Care | $144 | 496% |
| Allied National Global Care | $157 | 540% |
| Asrm - Reliance Standard Life Insurance | $157 | 540% |
| Avmed Health Plan | $157 | 540% |
| Christian Care Ministry | $157 | 540% |
| Dean Health | $157 | 540% |
| Fallon Health | $157 | 540% |
| Family Life Insurance Company | $157 | 540% |
| Freedom Life Insurance Company | $157 | 540% |
| Ghc Scw | $157 | 540% |
| International Benefit Administrators | $157 | 540% |
| Lifetime Benefit Solutions | $157 | 540% |
| Manhattan Life | $157 | 540% |
| Medi Share | $157 | 540% |
| Multiplan | $157 | 540% |
| Pai | $157 | 540% |
| Pan-American Life | $157 | 540% |
| Paramount Hmo | $157 | 540% |
| Phcs | $157 | 540% |
| Philadelphia American Life Insurance | $157 | 540% |
| Trinity Health Share | $157 | 540% |
| Bankers Life Casualty | $174 | 599% |
| Bureau Of Disability | $174 | 599% |
| Wc Align Network | $174 | 599% |
| Managed Health Services - Indiana | $186 | 640% |
| Mdwise | $186 | 640% |