CMS Price Transparency Data

Physical therapy (gait training)

Facility: Pawhuska Hospital, Inc

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $67
Cash Discount Price: $46
vs. Medicare Baseline: 2.31x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Pawhuska Hospital, Inc is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.31x the Medicare baseline. Located in 1101 East 15Th Street, Pawhuska, OK.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $46 (158%)

Insurance Median: $67 (231%)

Cash: $46 (158% of Medicare)

Ins. Median: $67 (231% 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 231% of the Medicare baseline (a markup of 131%). 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 - $67	141%
Aetna	$46 - $79	158%
Humana	$46 - $79	158%
Tricare	$46	158%
UnitedHealthcare	$46 - $199	158%
Wellcare Mcr Adv - All Plans	$46	158%
Healthchoice Ip/Op Only - All Plans	$50	172%
Healthcare Highways - All Plans	$51	175%
Cigna	$54	186%
Multiplan - All Plans	$59	203%
Ambetter / Centene	$69	237%
Community Care Comm - All Plans	$69	237%
Preferred Commchoice Ip/Op Only - All Plans	$71	244%
Soonerselect Mcaid - All Plans	$79	272%

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 $46.
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 Pawhuska Hospital, Inc 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.