CMS Price Transparency Data

Physical therapy (gait training)

Facility: Hammond Henry Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $120
Cash Discount Price: $149
vs. Medicare Baseline: 4.13x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Hammond Henry Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $149. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.13x the Medicare baseline. Located in 600 N College Avenue, Geneseo, IL.

Cash / Self-Pay

$149

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $149 (513%)

Insurance Median: $120 (413%)

Cash: $149 (513% of Medicare)

Ins. Median: $120 (413% 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 413% of the Medicare baseline (a markup of 313%). 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
Tricare	$43	148%
Aetna	$48 - $124	165%
Health Alliance Mcare Adv	$48	165%
UnitedHealthcare	$48 - $133	165%
Blue Cross Blue Shield	$72 - $100	248%
Meridian Health Plan-All Plans	$72	248%
Wellmark Of Ia-All Plans	$83	286%
Quad City Community Hc-All Plans	$90	310%
Springfield Armory-All Plans	$108	372%
Ambetter / Centene	$116	399%
Humana	$120	413%
Health Alliance-All Other Plans	$124	427%
Multiplan Integrated Hp	$124	427%
Cigna	$128	440%
Multiplan Pponext	$133	458%
Osf Direct Access Network-All Plans	$133	458%
Multiplan-All Other Plans	$141	485%
Corvel-All Plans	$149	513%
Healthsmart Adult-All Other Plans	$149	513%
Healthsmart Pediatric	$149	513%
Hfn-All Plans	$149	513%
Multiplan Beech Street	$149	513%
Multiplan Phcs Adult	$149	513%
Multiplan Phcs Pediatric	$149	513%
Usa Mco-All Plans	$149	513%

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 $149.
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 Hammond Henry 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.