CMS Price Transparency Data

Physical therapy (gait training)

Facility: Valor Health

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $91
Cash Discount Price: $99
vs. Medicare Baseline: 3.13x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Valor Health is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.13x the Medicare baseline. Located in 1202 East Locust Street, Emmett, ID.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$91

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: $99 (341%)

Insurance Median: $91 (313%)

Cash: $99 (341% of Medicare)

Ins. Median: $91 (313% 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 313% of the Medicare baseline (a markup of 213%). 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
Tricare	$45 - $50	155%
Aetna	$47 - $91	162%
Blue Cross Blue Shield	$47 - $107	162%
Blue Shield Mcr Adv	$47 - $51	162%
Humana	$47 - $107	162%
Molina Mcr Adv - All Plans	$47 - $51	162%
Regence Bs Triwest - All Plans	$47 - $51	162%
UnitedHealthcare	$47 - $101	162%
Pacificsource Mcr Adv	$49 - $54	169%
Cigna	$90 - $101	310%
Blue Shield Comm - All Other Plans	$95 - $104	327%
Moda Health - All Plans	$95 - $104	327%
Pacificsource Comm - All Other Plans	$95 - $104	327%
Select Health Comm - All Other Plans	$95 - $104	327%

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 $99.
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 Valor Health 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.