CMS Price Transparency Data

Physical therapy (gait training)

Facility: Monument Health Rapid City Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $26
Cash Discount Price: $64
vs. Medicare Baseline: 0.89x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Monument Health Rapid City Hospital is $26. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $64. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 0.89x the Medicare baseline. Located in 353 Fairmont Blvd, Rapid City, SD.

Cash / Self-Pay

$64

Average discount available for prompt cash payment at this facility.

Insurance Median

$26

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: $64 (220%)

Insurance Median: $26 (89%)

Cash: $64 (220% of Medicare)

Ins. Median: $26 (89% 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
Tricare	$6 - $29	21%
Minnesota Health Care Programs 12K16 [3081295]	$7 - $32	24%
Health Partners Sx009 [3081102]	$14 - $65	48%
Coresource 38225 [3081146]	$15 - $71	52%
Govt Employees Health Assn [3081090]	$15 - $69	52%
National Telephone Cooperative Assn 52103 [3081149]	$15 - $69	52%
Surest [3081369]	$15 - $69	52%
United Medical Resources 39026 [3081194]	$15 - $69	52%
UnitedHealthcare	$15 - $69	52%
Avera Health Plans 46045 [3081018]	$17 - $77	58%
Risk Admin Svs [3081167]	$18 - $84	62%
Rocky Mountain Admin Llc 83028 [3081168]	$18 - $84	62%
Medica (Commercial) 94265 [3081118]	$19 - $87	65%
Employee Benefit Management 12X44 [3081079]	$20 - $89	69%
Pacificsource Health Plans [3081333]	$20 - $89	69%
Tlc Advantage Llc [3081189]	$20 - $99	69%
Aetna	$21 - $94	72%
Group And Pension Administrators Inc [3081098]	$21 - $94	72%
Humana	$21 - $94	72%
Multiplan Inc 34080 [3081285]	$21 - $94	72%
Sanford Health Plan 91184 [3081174]	$21 - $94	72%
Allied Benefit Systems Inc [3081320]	$22 - $101	76%
Cigna	$22 - $101	76%
Fedmed Inc [3081283]	$22 - $100	76%
Key Benefit Administrators [3081332]	$22 - $101	76%
Meritain Health [3081135]	$22 - $101	76%
Midlands Choice 47080 [3081136]	$22 - $101	76%
Preferred One 41147 [3081160]	$22 - $101	76%
Medicare (plans)	$23 - $30	79%
Va Black Hills Health Care System 12115 [3081206]	$23 - $30	79%
Blue Cross Blue Shield	$24 - $80	83%

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 $64.
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 Monument Health Rapid City 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.