CMS Price Transparency Data

Physical therapy (gait training)

Facility: Portneuf Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $144
Cash Discount Price: $105
vs. Medicare Baseline: 4.96x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Portneuf Medical Center is $144. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.96x the Medicare baseline. Located in 777 Hospital Way, Pocatello, ID.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$144

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: $105 (361%)

Insurance Median: $144 (496%)

Cash: $105 (361% of Medicare)

Ins. Median: $144 (496% 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 496% of the Medicare baseline (a markup of 396%). 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
Bannock County Jail [6050]	$30	103%
Department Of Corrections [1340]	$30	103%
Medicaid / KanCare	$30	103%
Pending County Rca [3910]	$30	103%
UnitedHealthcare	$30 - $158	103%
Aetna	$36 - $148	124%
Healthscope Benefits [2290]	$36	124%
Black Lung [6055]	$72	248%
Employee Benefit Management Services [2445]	$72 - $105	248%
Healthcare Highways [2210]	$72 - $166	248%
Lucent Health [6000]	$72	248%
Moda Health [6100]	$72	248%
Oncology Patient Assistance Programs [2295]	$72	248%
Pending Ssi [1616]	$72	248%
Web Tpa [2115]	$72	248%
Pacific Source Health Plans [2850]	$101	348%
Liberty Health Share Lhs/Medcost Solutions Llc [2400]	$105	361%
Medishare Christian Care [1645]	$105	361%
Multiplan [1680]	$117 - $166	403%
Worker'S Comp [2125]	$127 - $131	437%
Enablecomp [1350]	$131	451%
Transamerican Life [1990]	$131	451%
First Health [1375]	$144	496%
Mailhandlers [1595]	$148	509%
Selecthealth [3740]	$148 - $158	509%
Cigna	$155	533%
Geha [1415]	$158	544%
Humana	$158	544%
Administrative Concepts [1005]	$166	571%
Healthfirst [2395]	$166	571%
Healthnet [1495]	$166	571%
Hometown Health [2155]	$166	571%
Mayo Clinic Health Solutions [2280]	$166	571%
Meritain Health [1655]	$166	571%
Mutual Of Omaha [1685]	$166	571%
National Association Of Letter Carriers [1695]	$166	571%
New Era Life Insurance Company [1705]	$166	571%
Pan American Life Insurance Co [1770]	$166	571%
Pba [1775]	$166	571%
Phcs [1780]	$166	571%
Planned Administrators Inc [2360]	$166	571%
Trustmark [2030]	$166	571%
Ut Id Teamsters [3760]	$166	571%

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 $105.
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 Portneuf 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.