CMS Price Transparency Data

Physical therapy (gait training)

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $82
Cash Discount Price: $106
vs. Medicare Baseline: 2.82x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Munson Healthcare Otsego Memorial Hospital is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $106. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.82x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$106

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

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: $106 (365%)

Insurance Median: $82 (282%)

Cash: $106 (365% of Medicare)

Ins. Median: $82 (282% 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 282% of the Medicare baseline (a markup of 182%). 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
Blue Cross Blue Shield	$15 - $79	52%
Mclaren Health Plan	$15 - $106	52%
Meridian	$15	52%
Molina	$15 - $30	52%
Priority Health	$15 - $85	52%
UnitedHealthcare	$15 - $102	52%
Aetna	$28 - $103	96%
Blue Care Network	$28	96%
Hap (Health Alliance Plan)	$28 - $102	96%
Humana	$28	96%
Medicare (plans)	$28	96%
Michigan Amish Medical Board	$28	96%
Northern Michigan Mennonite Group	$28	96%
Cigna	$41 - $85	141%
Asr Physicians Care Network	$42 - $102	145%
Nomi Health	$45 - $102	155%
Employee Benefit Logistics	$47	162%
Hospice Of Michigan	$73 - $76	251%
Munson Hospice	$85 - $852	292%
Enterprise Group Planning/Employee Benefit Plan	$98 - $102	337%
Cofinity	$104 - $108	358%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$104 - $108	358%
Three Rivers Provider Network	$104 - $108	358%

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 $106.
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 Munson Healthcare Otsego Memorial Hospital 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.