CMS Price Transparency Data

Physical therapy (gait training)

Facility: Baptist Memorial Hospital Union City

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $135
Cash Discount Price: $42
vs. Medicare Baseline: 4.65x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Baptist Memorial Hospital Union City is $135. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.65x the Medicare baseline. Located in 1201 Bishop St, Po Box 310, Union City, TN.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$135

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: $42 (145%)

Insurance Median: $135 (465%)

Cash: $42 (145% of Medicare)

Ins. Median: $135 (465% 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 465% of the Medicare baseline (a markup of 365%). 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
Aetna	$19 - $141	65%
Magnolia Tn	$40 - $47	138%
Blue Cross Blue Shield	$73 - $135	251%
Ppo Holdings	$73 - $86	251%
Magnolia Regional Health Center	$77 - $90	265%
Littler	$96 - $112	330%
UnitedHealthcare	$111 - $130	382%
Oscar	$117	403%
Humana	$127 - $148	437%
First Choice Health Plan Of Ms	$134 - $158	461%
Mpcn	$144 - $169	496%
Multiplan	$144 - $169	496%
Novasys	$144 - $169	496%
Cigna	$148 - $204	509%
Ppo Plus	$163 - $191	561%
Qca	$173 - $202	595%

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 $42.
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 Baptist Memorial Hospital Union City 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.