Physical therapy (gait training)
Facility: Clearsky Rehabilitation Hospital Of Elwood St Joseph Llc
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $81
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.79x 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 279% of the Medicare baseline (a markup of 179%). 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 |
|---|---|---|
| Multiplan | $77 | 265% |
| Cigna | $85 | 292% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Clearsky Rehabilitation Hospital Of Elwood St Joseph Llc, the negotiated rates from major payers like Cigna and Multiplan range from $77 to $85, which is significantly higher than the facility's cash price. While commercial insurance contracts often include administrative fees that inflate these amounts, patients with high-deductible plans may find paying cash directly cheaper if the negotiated rate exceeds the cash price. It is important to verify your specific deductible status before scheduling, as paying the full negotiated rate without meeting your plan's threshold can result in substantial out-of-pocket costs. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront, bypassing the costly insurance claims process.
The facility's billing practices align with standard industry benchmarks, where commercial negotiated rates typically average 200% to 300% of the Medicare rate of $29.06 for this procedure. Although the data does not provide specific county or state average comparisons for this code, understanding that Medicare represents the "true cost" baseline helps patients evaluate whether the commercial rates are reasonable or if they are being overcharged. If you receive a bill that seems unexpectedly high, you should request a detailed, itemized statement to check for errors such as double-billing or unbundled codes, as over 80% of hospital bills contain mistakes. Remember that under the No Surprises Act, you are protected from balance billing for out-of-network services at in-network facilities, so you should never feel pressured to sign away your rights or pay a surprise bill immediately.