CMS Price Transparency Data

Physical therapy (gait training)

Facility: Penn State Health Hampden Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $32
Cash Discount Price: $56
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Penn State Health Hampden Medical Center is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.10x the Medicare baseline. Located in 2200 Good Hope Road, Enola, PA.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $56 (193%)

Insurance Median: $32 (110%)

Cash: $56 (193% of Medicare)

Ins. Median: $32 (110% 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.

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
[Amerihealth Caritas]	$24 - $28	83%
[Highmark Wholecare]	$24 - $28	83%
[Geisinger]	$25 - $119	86%
[Health Partners Plans]	$26 - $29	89%
[Pa Health & Wellness]	$26 - $29	89%
Aetna	$28 - $77	96%
Humana	$28	96%
UnitedHealthcare	$28 - $112	96%
[Cbc]	$28 - $89	96%
[Healthspring]	$28	96%
[Highmark]	$28 - $83	96%
[Upmc]	$29 - $132	100%
[Point Comfort Underwriters]	$35	120%
[Highmark Choice Blue]	$67	231%
[Highmark Aca]	$70	241%
Cigna	$110	379%
[Preferred Healthcare Systems]	$134	461%
[First Health]	$143	492%
[Multiplan]	$143	492%

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 $56.
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 Penn State Health Hampden 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.