Physical therapy (gait training)
Facility: Salem Memorial District Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $154
- Cash Discount Price: $138
- vs. Medicare Baseline: 5.30x 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 530% of the Medicare baseline (a markup of 430%). 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 | $59 - $175 | 203% |
| Ambetter / Centene | $59 - $66 | 203% |
| Blue Cross Blue Shield | $59 - $120 | 203% |
| Humana | $59 - $165 | 203% |
| Tricare | $59 - $66 | 203% |
| Triwest | $59 - $66 | 203% |
| UnitedHealthcare | $59 - $104 | 203% |
| Veteran'S Affairs | $59 - $66 | 203% |
| Right Choice-Alliance | $88 | 303% |
| Right Choice-Regular | $100 | 344% |
| Healthlink | $113 - $126 | 389% |
| First Health | $139 - $155 | 478% |
| Mercy - C.B. Management Company/Joplin Supply Company | $139 - $155 | 478% |
| Mercy - City Of Springfield | $139 - $155 | 478% |
| Mercy - Clayco | $139 - $155 | 478% |
| Mercy - Commerce Bank | $139 - $155 | 478% |
| Mercy - Diversified Plastics | $139 - $155 | 478% |
| Mercy - Employers Benefit Alliance | $139 - $155 | 478% |
| Mercy - Evolutions | $139 - $155 | 478% |
| Mercy - Fabick Cat | $139 - $155 | 478% |
| Mercy - Firsthealth Network | $139 - $155 | 478% |
| Mercy - Health Management Network | $139 - $155 | 478% |
| Mercy - Health Systems Inc | $139 - $155 | 478% |
| Mercy - Liberty Utilities/Empire District Electric | $139 - $155 | 478% |
| Mercy - Life Church | $139 - $155 | 478% |
| Mercy - Missouri State University | $139 - $155 | 478% |
| Mercy - Prime Health Services | $139 - $155 | 478% |
| Mercy - Quiktrip Corporation | $139 - $155 | 478% |
| Mercy - Shinesolar | $139 - $155 | 478% |
| Mercy - Springfield Public Schools | $139 - $155 | 478% |
| Mercy - Springfield Remanufacturing | $139 - $155 | 478% |
| Mercy - Sumnerone | $139 - $155 | 478% |
| Mercy - Trailiner | $139 - $155 | 478% |
| Mercy - Walmart Mercy Accountable Care Plan | $139 - $155 | 478% |
| Mercy-American Healthcare Alliance | $139 - $155 | 478% |
| Phcs | $139 - $165 | 478% |
| Cigna | $147 - $165 | 506% |
| Mercy - Compresults | $156 - $175 | 537% |
| Mercy - Corvel Corporation | $156 - $175 | 537% |
| Mercy - Novasys | $156 - $175 | 537% |
| Mercy - Scurlock Industries | $156 - $175 | 537% |
| Mercy - Usa Managed Care Organization | $156 - $175 | 537% |