Physical therapy (gait training)
Facility: Orem Community Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $101
- Cash Discount Price: $123
- vs. Medicare Baseline: 3.48x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Donor Connect | $4 - $46 | 14% |
| Aetna | $28 - $139 | 96% |
| Health Partners Of Nevada | $28 - $29 | 96% |
| Health Plan Of Nevada | $28 - $49 | 96% |
| Healthy U | $28 - $29 | 96% |
| Humana | $28 - $29 | 96% |
| Molina | $28 - $155 | 96% |
| Selecthealth | $28 - $83 | 96% |
| Triwest | $28 | 96% |
| UnitedHealthcare | $28 - $139 | 96% |
| American Health | $29 | 100% |
| Blue Cross Blue Shield | $29 - $124 | 100% |
| Intermountain Caregiver Plan | $66 - $79 | 227% |
| Emi | $88 | 303% |
| Deseret Mutual | $94 | 323% |
| Cigna | $103 - $139 | 354% |
| Awh Connected | $104 - $105 | 358% |
| Emi Health | $113 | 389% |
| Byu Risk Management | $114 - $119 | 392% |
| Corporation Of The President | $114 - $119 | 392% |
| Pehp | $114 - $146 | 392% |
| Wcf Insurance | $114 - $119 | 392% |
| Byu Athletics | $118 | 406% |
| Campbell Scientific | $118 | 406% |
| Corvel Corporation | $118 | 406% |
| Franklin County | $118 | 406% |
| Ifit | $118 | 406% |
| Juniper Systems | $118 | 406% |
| Lw Miller | $118 | 406% |
| Tanner Llc | $118 | 406% |
| Utah Tech | $118 | 406% |
| Injury Care Of Nevada | $123 | 423% |
| Managed Care Admin | $128 | 440% |
| Prodegi Corp Benefit | $134 | 461% |
| Uofu | $134 | 461% |
| Springtide | $136 | 468% |
| Global Excel | $139 | 478% |
| Medcare International | $139 | 478% |
| Motivhealth | $139 | 478% |
| Wise Network | $139 | 478% |
| Hygeia Corporation | $147 | 506% |