CMS Price Transparency Data

Physical therapy (gait training)

Facility: Franciscan Health Munster

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $123
Cash Discount Price: $38
vs. Medicare Baseline: 4.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Franciscan Health Munster is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $38. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.23x the Medicare baseline. Located in 701 Superior Ave, Munster, IN.

Cash / Self-Pay

$38

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $38 (131%)

Insurance Median: $123 (423%)

Cash: $38 (131% of Medicare)

Ins. Median: $123 (423% 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 423% of the Medicare baseline (a markup of 323%). 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
Medicare (plans)	$28	96%
Aetna	$55	189%
Blue Cross Blue Shield	$55 - $135	189%
Commercial [2001]	$55 - $185	189%
Managed Care [2000]	$55 - $203	189%
Unicare [1150]	$55	189%
Workers Comp [1172]	$56	193%
Cigna	$76 - $123	262%
Great West Insurance [1055]	$123	423%
United Medical Resources [1158]	$185 - $203	637%
United Medical Resources [1301]	$185 - $203	637%
UnitedHealthcare	$185 - $203	637%
Mdwise [1175]	$186	640%
Medicaid / KanCare	$186 - $224	640%
Managed Health Services [1302]	$192	661%

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 $38.
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 Franciscan Health Munster 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.