CMS Price Transparency Data

Physical therapy (gait training)

Facility: Fairview Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $50
Cash Discount Price: $74
vs. Medicare Baseline: 1.72x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Fairview Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.72x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $74 (255%)

Insurance Median: $50 (172%)

Cash: $74 (255% of Medicare)

Ins. Median: $50 (172% 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	$21 - $58	72%
Health New England	$22 - $65	76%
Medicaid / KanCare	$22 - $65	76%
Point32Health	$25 - $74	86%
Bmchnp	$26 - $67	89%
Medicare (plans)	$29 - $30	100%
Other Government	$29 - $30	100%
Blue Cross Blue Shield	$30 - $66	103%
Commcare Alliance	$30 - $35	103%
Fallon	$30 - $34	103%
Hospice	$30	103%
UnitedHealthcare	$30 - $67	103%
Comm Fallon Qhp	$45 - $48	155%
Workers Comp	$49	169%
Allways Nhp	$50	172%
Unicare	$50 - $59	172%
Comm Hne Hmo	$53 - $55	182%
Comm Hne Ppo	$57 - $58	196%
Capital District Physicians' Health Plan	$70	241%
Cigna	$70 - $72	241%
Mvp	$70	241%
Oxford	$70	241%
First Health	$72 - $74	248%
Connecticare	$74	255%
Consolidated Health Plans	$74	255%
Other Commercial	$74	255%
Phcs	$74	255%
Self Pay	$74	255%

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 $74.
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 Fairview 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.