CMS Price Transparency Data

Physical therapy (gait training)

Facility: Madison County Health Care System

Billing Code: 97116 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$65

about 2.2× the $29 Medicare rate · typically $36–$145

modeled estimate · not a bill or quote

Medicare pays $29 Fair price $65 Cash price $101 Hospital's list price $126

How we calculate the fair BaseRate →

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna CignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$54 - $113	186%
Blue Cross Blue Shieldmajor	$136 - $150	468%
Aetnamajor	$54 - $82	186%
Amerigroup	$63	217%
Molina	$61	210%
Oscar Health	$81	279%
+ 14 smaller / regional plans	$54 - $126

Government programs also on file: Military & VA.

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 101), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97116.

Insurance Before you use insurance

Call your insurance company to confirm Madison County Health Care System is in-network.
Ask your insurer whether prior approval is required for CPT code 97116.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Madison County Health Care System

Compare: Physical therapy (gait training) at other IA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.