CMS Price Transparency Data

Physical therapy (gait training)

Facility: Titus Regional Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $61
Cash Discount Price: $58
vs. Medicare Baseline: 2.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Titus Regional Medical Center is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $58. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.10x the Medicare baseline. Located in 2001 N Jefferson, Mount Pleasant, TX.

Cash / Self-Pay

$58

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

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: $58 (200%)

Insurance Median: $61 (210%)

Cash: $58 (200% of Medicare)

Ins. Median: $61 (210% 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 210% of the Medicare baseline (a markup of 110%). 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	$18 - $45	62%
Christus Health Plan	$20	69%
Humana	$20 - $71	69%
Tricare	$20	69%
Triwest	$20	69%
UnitedHealthcare	$20 - $101	69%
Texas Mutual	$21	72%
Curative	$22 - $61	76%
Blue Cross Blue Shield	$24 - $94	83%
Claritev	$31 - $81	107%
Healthcare Highways	$35 - $40	120%
Superior	$40 - $46	138%
Healthsmart	$61 - $71	210%
Cigna	$70 - $81	241%
Galaxy Health	$83 - $96	286%

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 $58.
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 Titus Regional 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.