CMS Price Transparency Data

Physical therapy (gait training)

Facility: Baptist Memorial Hospital Tipton

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $122
Cash Discount Price: $54
vs. Medicare Baseline: 4.20x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Baptist Memorial Hospital Tipton is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.20x the Medicare baseline. Located in 1995 Highway 51 S, Covington, TN.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

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: $54 (186%)

Insurance Median: $122 (420%)

Cash: $54 (186% of Medicare)

Ins. Median: $122 (420% 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 420% of the Medicare baseline (a markup of 320%). 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
Magnolia Tn	$16 - $19	55%
Aetna	$19 - $75	65%
Blue Cross Blue Shield	$20 - $150	69%
Humana	$58	200%
Ppo Holdings	$78 - $95	268%
Magnolia Regional Health Center	$82 - $100	282%
Multiplan	$88 - $188	303%
Littler	$102 - $125	351%
Molina	$102 - $125	351%
Access Health Services	$122 - $150	420%
Butler Snow	$122 - $150	420%
UnitedHealthcare	$122 - $150	420%
Oscar	$130	447%
First Choice Health Plan Of Ms	$143 - $175	492%
Mpcn	$153 - $188	526%
Novasys	$153 - $188	526%
Ppo Plus	$173 - $212	595%
Qca	$184 - $225	633%
Cigna	$185 - $204	637%

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 $54.
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 Tipton 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.