CMS Price Transparency Data

Physical therapy (gait training)

Facility: Sanford Jackson Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $101
Cash Discount Price: $118
vs. Medicare Baseline: 3.48x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Sanford Jackson Medical Center is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $118. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.48x the Medicare baseline. Located in 1430 North Highway, Jackson, MN.

Cash / Self-Pay

$118

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $118 (406%)

Insurance Median: $101 (348%)

Cash: $118 (406% of Medicare)

Ins. Median: $101 (348% 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 348% of the Medicare baseline (a markup of 248%). 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	$36 - $136	124%
Sanford Health Plan Align	$46	158%
Aetna	$50 - $128	172%
Health Partners	$50 - $118	172%
Medicare (plans)	$50	172%
Ucare	$50 - $129	172%
UnitedHealthcare	$50 - $123	172%
Wellmark Sd	$50	172%
Primewest	$51 - $55	175%
Sanford Health Plan	$79 - $93	272%
Security Health Plan	$81	279%
Medica	$129 - $139	444%
Cigna	$132	454%
First Choice Health Network	$132	454%
Healthez	$132	454%
Multiplan	$132	454%

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 $118.
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 Sanford Jackson Medical Center 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.