CMS Price Transparency Data

Physical therapy (gait training)

Facility: Lovelace Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $123
Cash Discount Price: $90
vs. Medicare Baseline: 4.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Lovelace Medical Center is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.23x the Medicare baseline. Located in 601 Dr Martin Luther King Jr Ave Ne, Albuquerque, NM.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $90 (310%)

Insurance Median: $123 (423%)

Cash: $90 (310% of Medicare)

Ins. Median: $123 (423% 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 423% of the Medicare baseline (a markup of 323%). 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
The Health Plan [2915]	$61	210%
Healthscope Benefits [2290]	$77	265%
UnitedHealthcare	$77	265%
Corvel Corp [2235]	$121	416%
Enablecomp [1350]	$123	423%
Worker'S Comp [2125]	$123	423%
Benefit Management [1175]	$150	516%
Magellan Behavioral Commercial [2895]	$150	516%
Presbyterian Health Plan [1830]	$150	516%
Zelis [2385]	$150	516%

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 $90.
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 Lovelace 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.