CMS Price Transparency Data

Physical therapy (gait training)

Facility: Lower Bucks Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $31
Cash Discount Price: $29
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Lower Bucks Hospital is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.07x the Medicare baseline. Located in 501 Bath Road, Bristol, PA.

Cash / Self-Pay

$29

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $29 (100%)

Insurance Median: $31 (107%)

Cash: $29 (100% of Medicare)

Ins. Median: $31 (107% 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.

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
Health Partners Plan	$8 - $45	28%
Medicaid / KanCare	$8	28%
Keystone	$9 - $31	31%
UnitedHealthcare	$9 - $33	31%
Humana	$24	83%
Blue Cross Blue Shield	$30 - $82	103%
Medicare (plans)	$30 - $31	103%
Pa Health & Wellness	$30 - $36	103%
Tricare	$30	103%
Provider Patners Health Plan	$31	107%
Spartan Plan Pa	$31	107%
Auto Insurance	$33	114%
Worker Compensation	$34	117%
Employer Direct Healthcare	$42	145%
Highmark	$63	217%
Cigna	$180	619%

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 $29.
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 Lower Bucks Hospital 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.