Physical therapy (gait training)
Facility: Eastern New Mexico Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $124
- Cash Discount Price: $95
- vs. Medicare Baseline: 4.27x 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 427% of the Medicare baseline (a markup of 327%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $28 - $222 | 96% |
| Medicare (plans) | $28 | 96% |
| Node Champva | $28 | 96% |
| Node Hospice Non Par Agree | $28 | 96% |
| Node Molina Mcr Adv | $28 | 96% |
| Node Presbyterian Mcr Adv | $28 | 96% |
| Node Va | $28 | 96% |
| Tricare | $28 | 96% |
| Triwest | $28 | 96% |
| Veterans Eval Services | $28 | 96% |
| Humana | $29 | 100% |
| Node Devoted Health Mcr Adv | $29 | 100% |
| Node Western Sky Mcr Adv | $29 | 100% |
| UnitedHealthcare | $29 - $198 | 100% |
| Node Wexford Health | $35 | 120% |
| Us Dept Of Labor | $43 | 148% |
| Presbyterian Mcd | $50 | 172% |
| Medicaid / KanCare | $52 - $53 | 179% |
| Nm Work Comp | $59 - $114 | 203% |
| Health Connections | $62 | 213% |
| Self Pay | $67 - $124 | 231% |
| Node Molina Health Exchange | $76 | 262% |
| Capstar | $96 - $143 | 330% |
| Zelis Nmmip | $200 | 688% |
| Presbyterian Commercial | $213 | 733% |
| Cigna | $225 | 774% |
| Firstcare Tx | $238 | 819% |
| Admar | $254 | 874% |
| Omni | $254 - $301 | 874% |
| Multiplan Primary | $266 | 915% |
| Aetna | $267 | 919% |
| Healthsmart | $269 | 926% |
| Multiplan Complementary | $276 | 950% |
| Zelis | $279 | 960% |
| Affordable | $295 | 1015% |