CMS Price Transparency Data
Physical therapy (gait training)
Facility: Avoyelles Hospital
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $83
- Cash Discount Price: $28
- vs. Medicare Baseline: 2.86x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Avoyelles Hospital is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $28. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.86x the Medicare baseline. Located in 4231 Highway 1192, Marksville, LA.
Cash / Self-Pay
$28
Average discount available for prompt cash payment at this facility.
Insurance Median
$83
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: $28 (96%)
Insurance Median: $83 (286%)
Cash: $28 (96% of Medicare)
Ins. Median: $83 (286% 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 286% of the Medicare baseline (a markup of 186%). 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.
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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 | $19 - $52 | 65% |
| Cigna | $19 - $52 | 65% |
| Correct Cr Int Hlt | $19 | 65% |
| Mcd Amerihealth Caritas | $19 | 65% |
| Mcd Healthy Blue | $19 | 65% |
| Mcd La Hc Conn | $19 | 65% |
| Medicaid / KanCare | $19 | 65% |
| UnitedHealthcare | $19 - $28 | 65% |
| Mcd Ms | $21 | 72% |
| All Savers | $22 | 76% |
| Geha | $22 | 76% |
| United Hlth One | $22 | 76% |
| Humana | $26 - $52 | 89% |
| Bankers Life | $28 | 96% |
| Champva | $28 | 96% |
| Mcr Lagniappe | $28 | 96% |
| Medeico Ins Co | $28 | 96% |
| Medicare (plans) | $28 | 96% |
| Mmc Allwell | $28 | 96% |
| Mmc Blue Advantage | $28 | 96% |
| Mmc Healthy Blue Dual Adv | $28 | 96% |
| Mmc Mcr Hmo Miscellaneous | $28 | 96% |
| Mmc Priority Hlth Pffs | $28 | 96% |
| Mmc Vantage Hlth | $28 | 96% |
| Mmc Wellcare | $28 | 96% |
| Mutual Of Omaha | $28 | 96% |
| Neba Inc | $28 | 96% |
| Philadelphia American Lif | $28 | 96% |
| Sentinel Security Life | $28 | 96% |
| Student Assurances | $28 - $92 | 96% |
| Trustmark Health Benefits | $28 - $92 | 96% |
| Tunica Biloxi | $28 - $92 | 96% |
| United Amer Ins | $28 | 96% |
| Veterans Evaluation Serv | $28 | 96% |
| Wps Vacca | $28 | 96% |
| Gulf South Zelis | $36 | 124% |
| Amer Contl Ins | $41 - $52 | 141% |
| Coventry | $41 - $52 | 141% |
| First Choice Health | $41 - $52 | 141% |
| Meritan Health | $41 - $92 | 141% |
| Blue Cross Blue Shield | $46 | 158% |
| Ofc Of Grp Bene | $46 | 158% |
| Ppo Plus Llc | $56 | 193% |
| Zelis Healthcare Bpa | $56 | 193% |
| Gilsbar | $58 | 200% |
| Amerind | $83 | 286% |
| Applied Underwriters | $83 | 286% |
| Sedgwick | $83 | 286% |
| Us Dept Of Labor | $83 | 286% |
| Wc Clms Admin Svcs | $83 | 286% |
| Wc Clms Mgmnt Walmart | $83 | 286% |
| Wc Esis | $83 | 286% |
| Wc Fara | $83 | 286% |
| Wc Gallagher Bassett | $83 | 286% |
| Wc Guide One | $83 | 286% |
| Wc Hartford Med | $83 | 286% |
| Wc Luba | $83 | 286% |
| Wc Lwcc | $83 | 286% |
| Wc Paragon Casino Resort | $83 | 286% |
| Wc Risk Mgmnt | $83 | 286% |
| Wc Stone Trust | $83 | 286% |
| Wc Summit Consulting Hold | $83 | 286% |
| Wc Travelers Ins | $83 | 286% |
| Wc Trs Workers Comp Claim | $83 | 286% |
| Wc Us Dol | $83 | 286% |
| Wc Zurich | $83 | 286% |
| Aarp | $92 | 317% |
| Admin Concepts | $92 | 317% |
| All Saints Hospice | $92 | 317% |
| All State | $92 | 317% |
| Allegiance Health Hospice | $92 | 317% |
| Allied Natl | $92 | 317% |
| Amfirst | $92 | 317% |
| Avoy Parish School Board | $92 | 317% |
| Avoyelles Parish Sheriff | $92 | 317% |
| Bollinger | $92 | 317% |
| Ccmsi | $92 | 317% |
| Central States | $92 | 317% |
| Christus Health Plan | $92 | 317% |
| Compassionate Care Hospic | $92 | 317% |
| Core Source | $92 | 317% |
| Coushatta Hlth Dept | $92 | 317% |
| Ebms | $92 | 317% |
| Federated Ins | $92 | 317% |
| Feedom Life | $92 | 317% |
| Fidelity Standard Life Co | $92 | 317% |
| Fox Everette | $92 | 317% |
| Guarantee Trust | $92 | 317% |
| Heart Of Hospice | $92 | 317% |
| Hos Christus Hospice | $92 | 317% |
| Hos Guardian Hospice Care | $92 | 317% |
| Hos Harbor Hospice Alex | $92 | 317% |
| Hos La Hospice Palliative | $92 | 317% |
| Hos Passages Hospice N. | $92 | 317% |
| Hos St Joseph Hospice | $92 | 317% |
| Hospice Miscellaneous | $92 | 317% |
| Ins Mgmnt Admin | $92 | 317% |
| Ins Tpa | $92 | 317% |
| Liberty Health Share | $92 | 317% |
| Lumico | $92 | 317% |
| Manhattan Life Ins | $92 | 317% |
| Medi Share | $92 | 317% |
| Misc Comm | $92 | 317% |
| Nalc | $92 | 317% |
| New Era Life | $92 | 317% |
| North American | $92 | 317% |
| Phcs | $92 | 317% |
| Physicians Mutual | $92 | 317% |
| Pipeline Ind Bene | $92 | 317% |
| Progressive Auto | $92 | 317% |
| Reliance Standard Life | $92 | 317% |
| Rural Carriers | $92 | 317% |
| Shelter Ins Co | $92 | 317% |
| Sierre Health And Life | $92 | 317% |
| State Farm | $92 | 317% |
| State Mutual | $92 | 317% |
| Sterling Investors | $92 | 317% |
| The Health Plan | $92 | 317% |
| Tribal Hlth Partners | $92 | 317% |
| Tricare | $92 | 317% |
| Uct | $92 | 317% |
| Unified Life | $92 | 317% |
| Usaa Life Ins | $92 | 317% |
| Web-Tpa | $92 | 317% |
| Woodmen Of The World | $92 | 317% |