CMS Price Transparency Data

Physical therapy (gait training)

Facility: Medical Center Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $57
Cash Discount Price: $72
vs. Medicare Baseline: 1.96x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Medical Center Hospital is $57. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.96x the Medicare baseline. Located in 500 W 4Th Street, Odessa, TX.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$57

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: $72 (248%)

Insurance Median: $57 (196%)

Cash: $72 (248% of Medicare)

Ins. Median: $57 (196% 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
Corvel Wc	$15	52%
Medicaid / KanCare	$15 - $16	52%
Superior Chips	$15	52%
UnitedHealthcare	$17 - $160	58%
Aetna	$28 - $75	96%
Care Improvement Plus	$28	96%
Humana	$28	96%
Novitas Solutions	$28	96%
Triwest Va Ccn	$28	96%
Ambetter / Centene	$29	100%
Wellcare By Allwell	$29	100%
Group Resources	$34	117%
Blue Cross Blue Shield	$43 - $76	148%
Health Select	$49 - $57	169%
90 Degree Benefits	$54 - $91	186%
State Comptroller	$56	193%
Workers Comp	$57	196%
Healthsmart Preferred Care	$68 - $96	234%
Texas Mutual Wc	$75	258%
Caprock	$88 - $103	303%
Firstcare	$110	379%
Geha	$147	506%
Cigna	$218	750%

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 $72.
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 Medical Center 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.