CMS Price Transparency Data

Physical therapy (gait training)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $72
Cash Discount Price: $190
vs. Medicare Baseline: 2.48x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at UMass Memorial Healthalliance Hospitals is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $190. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.48x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$190

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $190 (654%)

Insurance Median: $72 (248%)

Cash: $190 (654% of Medicare)

Ins. Median: $72 (248% 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 248% of the Medicare baseline (a markup of 148%). 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
Workers Compensation [20501]	$20	69%
Champva [11001]	$30	103%
Cigna	$30 - $85	103%
Correctional Care [11003]	$30 - $47	103%
Institution [10406]	$30 - $101	103%
Medicare (plans)	$30	103%
Tufts Dual [10111]	$30	103%
Tufts Us Family [11203]	$30	103%
Aetna	$31 - $124	107%
Blue Cross Blue Shield	$31 - $196	107%
Fallon Mcr Supp [20202]	$31	107%
Tufts Mcr [10112]	$31	107%
UnitedHealthcare	$31 - $190	107%
Commonwealth Care Mcr [10115]	$32	110%
Harvard Pilgrim Mcr [10106]	$32	110%
Mgb Mcr [10124]	$32	110%
Senior Whole Health [10110]	$32	110%
Tufts Connectorcare [10507]	$52	179%
Wellpoint [11112]	$63	217%
Fallon Connectorcare [10503]	$72	248%
Tufts [11201]	$77	265%
Medicaid / KanCare	$84 - $99	289%
Hne [11108]	$106	365%
First Health Network [11120]	$142	489%
Multiplan [11109]	$142	489%
Harvard Pilgrim [10701]	$185 - $222	637%
Connecticare [11105]	$190	654%
Fallon Carelon Hlth [28]	$190	654%
Fallon Mcaid Carelon Hlth [29]	$190	654%
Grants [20507]	$190	654%
Hsno/Free Care [10801]	$294	1012%

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 $190.
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 UMass Memorial Healthalliance Hospitals 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.