CMS Price Transparency Data

Physical therapy (gait training)

Facility: Gunnison Valley Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $90
Cash Discount Price: $93
vs. Medicare Baseline: 3.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Gunnison Valley Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $93. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.10x the Medicare baseline. Located in 711 N Taylor St, Gunnison, CO.

Cash / Self-Pay

$93

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $93 (320%)

Insurance Median: $90 (310%)

Cash: $93 (320% of Medicare)

Ins. Median: $90 (310% 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 310% of the Medicare baseline (a markup of 210%). 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
Medicaid / KanCare	$38	131%
Medicare (plans)	$54	186%
Gunnison County Coroner Op Only	$56	193%
Gunnison County Sheriff Op & Profee Only	$56	193%
Ebms Hdhp	$66	227%
Tetwp Op & Profee Only-All Plans	$66	227%
U Of Co Transplant-All Plans	$66	227%
Ebms Ppo Plan-All Other Plans	$77	265%
Gunnison County Employees-All Other Plans	$87	299%
Scottish Rites-All Plans	$87	299%
Elap Employers-All Plans	$93	320%
Blue Cross Blue Shield	$96	330%
Apostrophe-All Plans	$98	337%
Multiplan-All Plans	$102	351%
Rocky Mountain Health-All Plans	$104	358%
UnitedHealthcare	$104	358%
Aetna	$105	361%
Cofinity-All Plans	$105	361%
Cigna	$107	368%

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 $93.
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 Gunnison Valley 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.