CMS Price Transparency Data

Physical therapy (gait training)

Facility: Gundersen Lutheran Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $63
Cash Discount Price: $50
vs. Medicare Baseline: 2.17x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Gundersen Lutheran Medical Center is $63. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.17x the Medicare baseline. Located in 1910 South Ave, La Crosse, WI.

Cash / Self-Pay

$50

Average discount available for prompt cash payment at this facility.

Insurance Median

$63

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: $50 (172%)

Insurance Median: $63 (217%)

Cash: $50 (172% of Medicare)

Ins. Median: $63 (217% 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 217% of the Medicare baseline (a markup of 117%). 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
Amerigroup	$12 - $37	41%
Blue Cross Blue Shield	$12 - $486	41%
Group Health Eau Claire	$12 - $120	41%
Group Health Of South Central	$12 - $106	41%
Icare	$12 - $37	41%
Iowa Total Care	$12	41%
Managed Health Service	$12	41%
Molina Health	$12	41%
UnitedHealthcare	$12 - $108	41%
Aetna	$37 - $126	127%
Medical Associates	$37 - $100	127%
Ucare	$37 - $106	127%
Medica	$44 - $102	151%
Dean Health Plan	$56	193%
Quartz	$56	193%
Health Partners	$66 - $117	227%
Midland Choice	$100	344%
Alliance	$104 - $155	358%
Claim Doc Llc	$106	365%
Wps Narrow Network	$108	372%
Cigna	$109	375%
Wps - Arise	$109	375%
Aspirus Arise Health	$110	379%
Allied National General	$113	389%
Preferred One	$113	389%
Wps Statewide	$113	389%
Coventry Health Care	$126	434%
Humana	$126	434%
Multiplan/Healtheos	$128	440%

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 $50.
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 Gundersen Lutheran 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.