CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mountain West Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $96
Cash Discount Price: $78
vs. Medicare Baseline: 3.30x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mountain West Medical Center is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.30x the Medicare baseline. Located in 2055 North Main Street, Tooele, UT.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $78 (268%)

Insurance Median: $96 (330%)

Cash: $78 (268% of Medicare)

Ins. Median: $96 (330% 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 330% of the Medicare baseline (a markup of 230%). 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	$28 - $31	96%
Select Health McR Adv	$28	96%
Medicare (plans)	$35	120%
Wise/Motivhealth-All Plans	$83 - $86	286%
U of Ut-All Plans	$83 - $86	286%
Cigna	$90 - $94	310%
Dmba-All Plans	$92 - $96	317%
Pehp-All Plans	$96 - $100	330%
Select Health-All Other Plans	$96 - $100	330%
Aetna	$96 - $100	330%
UnitedHealthcare	$98 - $102	337%
Multiplan Primary Network-All Other Plans	$101 - $105	348%
Emi-All Plans	$108 - $113	372%
Humana	$108 - $113	372%
Multiplan Complimentary Network	$117 - $122	403%

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 $78.
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 Mountain West 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.