CMS Price Transparency Data

Physical therapy (gait training)

Facility: Holyoke Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $36
Cash Discount Price: $68
vs. Medicare Baseline: 1.24x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Holyoke Medical Center is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.24x the Medicare baseline. Located in 575 Beech Street, Holyoke, MA.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $68 (234%)

Insurance Median: $36 (124%)

Cash: $68 (234% of Medicare)

Ins. Median: $36 (124% 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.

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	$30 - $89	103%
Blue Cross Blue Shield	$30	103%
Health New England	$30 - $149	103%
Tufts Health Plan	$30 - $57	103%
UnitedHealthcare	$30 - $207	103%
Commonwealth Care Alliance	$31	107%
Fallon	$32 - $36	110%
Wellcare	$32	110%
Wellsense Sco	$32	110%
Senior Whole Health	$34	117%
Bmchp	$36	124%
Tufts Health Public Plans	$36	124%
Wellsense Direct Metals Silver	$45	155%
Gic Unicare	$48	165%
Harvard Pilgrim	$80 - $89	275%
Cigna	$170	585%

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 $68.
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 Holyoke Medical Center 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.