CMS Price Transparency Data

Physical therapy (gait training)

Facility: Memorial Health Care Systems

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $65
Cash Discount Price: $112
vs. Medicare Baseline: 2.24x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Memorial Health Care Systems is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.24x the Medicare baseline. Located in 300 North Columbia Ave, Seward, NE.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $112 (385%)

Insurance Median: $65 (224%)

Cash: $112 (385% of Medicare)

Ins. Median: $65 (224% 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 224% of the Medicare baseline (a markup of 124%). 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
Molina Mcaid-All Plans	$60	206%
Ne Total Care Mcaid-All Plans	$60	206%
UnitedHealthcare	$60 - $110	206%
Beshp Mcr Adv - All Plans	$64	220%
Blue Cross Blue Shield	$64 - $106	220%
Medica Mcare Cost	$64	220%
Medica Mcr Adv	$64	220%
Tricare	$64	220%
Wellcare Mcr Adv - All Plans	$65	224%
Phcs Ppo-All Plans	$106	365%
Ambetter / Centene	$108	372%
Medica Comm-All Other Plans	$108	372%
Medica Elevate	$108	372%
Midlands Choice-All Plans	$109	375%
Aetna	$110	379%

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 $112.
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 Memorial Health Care Systems 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.