CMS Price Transparency Data

Physical therapy (gait training)

Facility: St Luke's Wood River Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $65
Cash Discount Price: $72
vs. Medicare Baseline: 2.24x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at St Luke's Wood River Medical Center is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.24x the Medicare baseline. Located in 100 Hospital Drive, Ketchum, ID.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $72 (248%)

Insurance Median: $65 (224%)

Cash: $72 (248% of Medicare)

Ins. Median: $65 (224% 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 224% of the Medicare baseline (a markup of 124%). 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
Blue Cross Blue Shield	$41 - $62	141%
Commercial [1028]	$41 - $70	141%
Medicare (plans)	$41 - $42	141%
Veterans Affairs [1056]	$41	141%
UnitedHealthcare	$43 - $65	148%
Aetna	$45 - $68	155%
Moda [1055]	$63	217%
Geha [1065]	$65	224%
United Medical Resources [1051]	$65	224%
Cigna	$67	231%
Providence [1022]	$67	231%
First Health [1064]	$68 - $70	234%
Pacificsource [1020]	$68	234%
Webtpa [1071]	$68	234%

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 $72.
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 St Luke's Wood River 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.