CMS Price Transparency Data

Physical therapy (gait training)

Facility: Shannon Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $101
Cash Discount Price: $77
vs. Medicare Baseline: 3.48x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Shannon Medical Center is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $77. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.48x the Medicare baseline. Located in 120 E Harris Ave., San Angelo, TX.

Cash / Self-Pay

$77

Average discount available for prompt cash payment at this facility.

Insurance Median

$101

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: $77 (265%)

Insurance Median: $101 (348%)

Cash: $77 (265% of Medicare)

Ins. Median: $101 (348% 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 348% of the Medicare baseline (a markup of 248%). 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
City Of San Angelo	$19 - $24	65%
Care Improvement	$28	96%
Humana	$28 - $140	96%
Wellmed	$28	96%
Wellpoint	$38	131%
Scott & White	$45 - $150	155%
Insurance Management Services	$46	158%
Insurance Services Of Lubbock	$46	158%
Kempton Group	$56	193%
Pdh/Texas Trust	$56	193%
Ambetter / Centene	$60	206%
Web Tpa	$60 - $79	206%
90 Degree Benefits	$70	241%
Caprock	$70	241%
Aetna	$88 - $116	303%
Assurant Health	$88 - $116	303%
Cigna	$96 - $126	330%
Blue Cross Blue Shield	$100 - $131	344%
First Health	$100 - $131	344%
UnitedHealthcare	$105 - $136	361%
Healthsmart	$119 - $156	409%

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 $77.
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 Shannon 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.