CMS Price Transparency Data

Physical therapy (gait training)

Facility: Warner Hospital and Health Services

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $123
Cash Discount Price: $151
vs. Medicare Baseline: 4.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Warner Hospital and Health Services is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.23x the Medicare baseline. Located in 422 W White St, Clinton, IL.

Cash / Self-Pay

$151

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $151 (520%)

Insurance Median: $123 (423%)

Cash: $151 (520% of Medicare)

Ins. Median: $123 (423% 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 423% of the Medicare baseline (a markup of 323%). 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	$60 - $149	206%
Aetna	$62 - $129	213%
Health Alliance Med Adv	$62	213%
Humana	$62 - $129	213%
Molina Mcr/Mcd Dual	$62	213%
UnitedHealthcare	$62 - $129	213%
Wellcare Mcr Adv-All Plans	$62	213%
Harmony Hp Mcaid-All Plans	$115	396%
Medicaid / KanCare	$115	396%
Meridian Hp-All Plans	$115	396%
Molina-All Other Plans	$115	396%
Healthlink Hmo	$118	406%
City Of Clinton (Employees Serv)-All Plans	$121	416%
Cigna	$125 - $126	430%
Caterpillar-All Plans	$128 - $129	440%
Multiplan Phcs-All Plans	$128 - $129	440%
Health Alliance-All Other Plans	$133 - $134	458%
Healthlink Ppo/Work Comp-All Other Plans	$133 - $134	458%
Consociate Care Ppo-All Plans	$136 - $137	468%
Hfn Ppo/Epo-All Plans	$136 - $137	468%
Three Rivers-All Plans	$143 - $144	492%

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 $151.
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 Warner Hospital and Health Services 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.