CMS Price Transparency Data

Physical therapy (gait training)

Facility: Thomas H Boyd Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $95
Cash Discount Price: $103
vs. Medicare Baseline: 3.27x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Thomas H Boyd Memorial Hospital is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.27x the Medicare baseline. Located in 800 School St, Carrollton, IL.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $103 (354%)

Insurance Median: $95 (327%)

Cash: $103 (354% of Medicare)

Ins. Median: $95 (327% 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 327% of the Medicare baseline (a markup of 227%). 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
Aetna	$66 - $158	227%
Blue Cross Blue Shield	$66 - $158	227%
Health Alliance Mcr Adv	$66	227%
Humana	$66	227%
UnitedHealthcare	$66 - $182	227%
Wellcare Mcr Adv-All Plans	$66	227%
Health Alliance-All Other Plans	$79	272%
Ambetter / Centene	$86	296%
Cigna	$92	317%
Multiplan-All Plans	$97	334%
Healthlink Hmo	$98	337%
Healthlink Il Only	$98	337%
Healthlink Ppo-All Other Plans	$111	382%
Hfn Zelis-All Plans	$117	403%
Meridian Hp Mcaid-All Plans	$158	544%
Molina Mcaid-All Plans	$158	544%

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 $103.
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 Thomas H Boyd Memorial 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.