CMS Price Transparency Data

Physical therapy (gait training)

Facility: Cook Childrens Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $31
Cash Discount Price: $36
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Cook Childrens Medical Center is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.07x the Medicare baseline. Located in 801 Seventh Avenue, Fort Worth, TX.

Cash / Self-Pay

$36

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $36 (124%)

Insurance Median: $31 (107%)

Cash: $36 (124% of Medicare)

Ins. Median: $31 (107% 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
Beacon	$12 - $31	41%
Firstcare	$12 - $102	41%
Health Plan W/O Uhrip	$12 - $33	41%
Health Plan W. Uhrip	$16 - $49	55%
Rightcare	$16 - $43	55%
Blue Cross Blue Shield	$17 - $107	58%
United Community	$17	58%
Wellpoint	$17	58%
Molina	$18 - $47	62%
El Paso Health First	$21 - $56	72%
Superior Health	$21	72%
Tx Children Health	$21 - $56	72%
UnitedHealthcare	$21 - $109	72%
Aetna	$23 - $64	79%
S&W Health	$40 - $107	138%
Cigna	$41 - $109	141%
Healthscope	$41 - $109	141%
Imagine Health	$41 - $109	141%
First Health	$42 - $113	145%
Humana	$42 - $113	145%
Multiplan	$42 - $111	145%
Galaxy Health	$43 - $115	148%
Healthsmart	$43	148%
Usamco	$44 - $118	151%

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 $36.
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 Cook Childrens 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.