CMS Price Transparency Data

Physical therapy (gait training)

Facility: Baylor University Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $126
Cash Discount Price: $121
vs. Medicare Baseline: 4.34x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Baylor University Medical Center is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.34x the Medicare baseline. Located in 3500 Gaston Ave, Dallas, TX.

Cash / Self-Pay

$121

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $121 (416%)

Insurance Median: $126 (434%)

Cash: $121 (416% of Medicare)

Ins. Median: $126 (434% 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 434% of the Medicare baseline (a markup of 334%). 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
Superior Health Plan	$38	131%
Wellpoint (Fka Amerigroup)	$38	131%
Texas Workforce Commission	$73	251%
Blue Cross Blue Shield	$90 - $190	310%
Baylor Scott & White Health Plan	$99 - $117	341%
Aetna	$105 - $121	361%
UnitedHealthcare	$108 - $141	372%
Employers Health Network	$111	382%
Quiktrip	$111	382%
University Of Mary Hardin-Baylor	$117	403%
Imagine Health	$126	434%
Cigna	$128 - $151	440%
Ambetter / Centene	$131	451%
Curative	$131	451%
First Health	$141	485%
Healthsmart	$141 - $151	485%
Humana	$141	485%
Private Health Care System	$151	520%
Triwest	$151	520%

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 $121.
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 Baylor University 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.