CMS Price Transparency Data

Physical therapy (gait training)

Facility: Gundersen Palmer Lutheran Hospital and Clinics

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $52
Cash Discount Price: $53
vs. Medicare Baseline: 1.79x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Gundersen Palmer Lutheran Hospital and Clinics is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.79x the Medicare baseline. Located in 112 Jefferson Street, West Union, IA.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $53 (182%)

Insurance Median: $52 (179%)

Cash: $53 (182% of Medicare)

Ins. Median: $52 (179% 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
Amerigroup	$12 - $49	41%
Molina Health	$12	41%
Health Partners	$47 - $83	162%
UnitedHealthcare	$47 - $49	162%
Wellmark	$48 - $78	165%
Humana	$49	169%
Iowa Total Care	$49	169%
Managed Health Service	$49	169%
Ucare	$49 - $75	169%
Quartz	$51	175%
Alliance	$74 - $155	255%
Medical Associates	$75	258%
Aspirus Arise Health	$78	268%
Multiplan/Healtheos	$83 - $87	286%
Coventry Health Care	$89	306%
Midland Choice	$91	313%

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 $53.
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 Gundersen Palmer Lutheran Hospital and Clinics 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.