CMS Price Transparency Data

Physical therapy (gait training)

Facility: Spanish Peaks Regional Health Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $50
Cash Discount Price: $88
vs. Medicare Baseline: 1.72x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Spanish Peaks Regional Health Center is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.72x the Medicare baseline. Located in 23500 Us Highway 160, Walsenburg, CO.

Cash / Self-Pay

$88

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $88 (303%)

Insurance Median: $50 (172%)

Cash: $88 (303% of Medicare)

Ins. Median: $50 (172% 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
Humana	$30 - $50	103%
Kaiser Ppo Mcr	$30 - $103	103%
Medicare (plans)	$30 - $50	103%
UnitedHealthcare	$30 - $96	103%
Devoted Health Mcr - All Plans	$32 - $53	110%
Apostrophe - All Plans	$39 - $93	134%
Blue Cross Blue Shield	$39 - $93	134%
Cofinity - All Plans	$39 - $95	134%
Connect For Health - All Plans	$39 - $96	134%
Friday Hp Chp - All Plans	$39 - $93	134%
Prov Ntwrk Of America - All Plans	$42 - $93	145%
Rmhp - All Plans	$45 - $96	155%
Beacon Health Op Only-All Plans	$47 - $92	162%
Kaiser Ppo - All Other Plans	$48 - $93	165%
Cigna	$83 - $93	286%
Multiplan Phcs - All Plans	$83 - $98	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 $88.
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 Spanish Peaks Regional Health 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.