Physical therapy (gait training)
Facility: Claiborne Memorial Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $73
- Cash Discount Price: $86
- vs. Medicare Baseline: 2.51x 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 251% of the Medicare baseline (a markup of 151%). 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 | $28 - $56 | 96% |
| Arcadian Community Mcr Hm | $28 | 96% |
| Blue Cross Blue Shield | $28 - $82 | 96% |
| Champus | $28 | 96% |
| Champva | $28 | 96% |
| Cigna | $28 - $64 | 96% |
| Healthy Blue Dual Adv | $28 | 96% |
| Humana | $28 - $86 | 96% |
| Kaiser Foundation Health | $28 | 96% |
| Medicare (plans) | $28 | 96% |
| Peoples Health Network | $28 | 96% |
| Pyramid Claims Mcr Hmo | $28 | 96% |
| Sterling Connect 2 | $28 | 96% |
| Sterling Premier Mc Hmo | $28 | 96% |
| Superior Health Mcr Hmo | $28 | 96% |
| Tenet Mcr Hmo | $28 | 96% |
| Tricare | $28 | 96% |
| United Hc Mcr Hmo | $28 | 96% |
| UnitedHealthcare | $28 - $37 | 96% |
| Universal Hc Mcr Hmo | $28 | 96% |
| Us Dept Of Labor | $28 | 96% |
| Vantage Health Mcr Hmo | $28 | 96% |
| Windsor Sterling Mcr Hmo | $28 | 96% |
| Wps Mvh Vapc3 | $28 | 96% |
| Vantage Health Plan Inc | $29 - $33 | 100% |
| Commercial Insurance | $34 - $86 | 117% |
| Meritain Health | $34 - $56 | 117% |
| Amerihealth Caritas La | $37 | 127% |
| Community Health Solution | $37 | 127% |
| Correctcare Intergrated | $37 | 127% |
| Healthy Blue | $37 | 127% |
| Louisiana Hc Connections | $37 | 127% |
| Magellan Services | $37 | 127% |
| Medicaid / KanCare | $37 | 127% |
| Sedgwick Claims Mgmt Serv | $38 - $77 | 131% |
| Workman'S Comp | $38 - $77 | 131% |
| Coventry Healthcare | $51 | 175% |
| Geha | $60 | 206% |
| Health Plus Of La | $60 - $64 | 206% |
| Apwu Healthplan | $64 | 220% |
| Great West Healthcare | $64 | 220% |
| Phcs | $69 | 237% |
| Ppo Plus | $69 | 237% |
| Aarp | $86 | 296% |
| Accordia National | $86 | 296% |
| Aflac | $86 | 296% |
| Alameda Alliance Forhealt | $86 | 296% |
| American Pioneer | $86 | 296% |
| Benefit Management | $86 | 296% |
| Benesys Inc | $86 | 296% |
| Business Guarantor | $86 | 296% |
| Chubb | $86 | 296% |
| Commercial Sr. Care | $86 | 296% |
| Employee Benefit Services | $86 | 296% |
| Family Life Insurance Co | $86 | 296% |
| Farm Bureau Insurance | $86 | 296% |
| Fiserv Health Benefit | $86 | 296% |
| Gmp | $86 | 296% |
| Group And Pension Admin | $86 | 296% |
| Group Resources | $86 | 296% |
| Haik Minvielle And Grubbs | $86 | 296% |
| Harrington Benefit Svs | $86 | 296% |
| Health Design Plus | $86 | 296% |
| Health Plan | $86 | 296% |
| Healthscope Benefits | $86 | 296% |
| Insurance Management Admi | $86 | 296% |
| Jefferson National | $86 | 296% |
| John Alden Health Ins | $86 | 296% |
| John Hancock | $86 | 296% |
| Liberty Mutual | $86 | 296% |
| Mailhandlers Benefit Plan | $86 | 296% |
| Manhattan Life Ins Co | $86 | 296% |
| Mega Life And Health | $86 | 296% |
| Msa Careguard | $86 | 296% |
| Mutual Of Omaha | $86 | 296% |
| Nalc Health Benefit Plan | $86 | 296% |
| Naphcare Inc. | $86 | 296% |
| New Era Life Ins Co | $86 | 296% |
| Physicians Mutual | $86 | 296% |
| Principal Financial Group | $86 | 296% |
| Prudential Healthcare | $86 | 296% |
| Self Pay | $86 | 296% |
| State Farm | $86 | 296% |
| State Farm Insurance | $86 | 296% |
| State Mutual Insurance Co | $86 | 296% |
| Sterling Investors Life | $86 | 296% |
| Tower Life | $86 | 296% |
| Transamerica Premier Ins | $86 | 296% |
| United American | $86 | 296% |
| United Comm Travelers | $86 | 296% |
| United Teachers | $86 | 296% |
| Usable Administrator | $86 | 296% |
| Visn 16 Cfu | $86 | 296% |
| Wausau Benefits | $86 | 296% |
| Webtpa | $86 | 296% |
| Wells Fargo | $86 | 296% |
| Woodmen Of The World | $86 | 296% |