CMS Price Transparency Data

Physical therapy (gait training)

Facility: Elkhart General Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $86
Cash Discount Price: $85
vs. Medicare Baseline: 2.96x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Elkhart General Hospital is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.96x the Medicare baseline. Located in 600 E Blvd, Elkhart, IN.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $85 (292%)

Insurance Median: $86 (296%)

Cash: $85 (292% of Medicare)

Ins. Median: $86 (296% 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 296% of the Medicare baseline (a markup of 196%). 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
Mclaren (Mi	$15	52%
UnitedHealthcare	$15 - $88	52%
Blue Cross Blue Shield	$23 - $52	79%
Devoted Healthcare	$26 - $29	89%
Aetna	$28 - $89	96%
Humana	$28 - $92	96%
Pace	$28	96%
Plain Church	$41 - $105	141%
Caresource	$44 - $170	151%
Mhs	$50 - $170	172%
Cha	$79 - $102	272%
Immergrun	$79 - $105	272%
Php	$85 - $92	292%
Cigna	$94 - $100	323%
Multiplan	$94	323%
Signature	$96	330%
Encore	$97	334%
Heartland	$131	451%
Mdwise	$170	585%

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 $85.
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 Elkhart General 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.