CMS Price Transparency Data

Physical therapy (gait training)

Facility: Holland Community Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $69
Cash Discount Price: $61
vs. Medicare Baseline: 2.37x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Holland Community Hospital is $69. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.37x the Medicare baseline. Located in 602 Michigan Ave, Holland, MI.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$69

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: $61 (210%)

Insurance Median: $69 (237%)

Cash: $61 (210% of Medicare)

Ins. Median: $69 (237% 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 237% of the Medicare baseline (a markup of 137%). 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
Life Circles-All Plans	$27	93%
Health Alliance Mcr Adv	$28	96%
Ph Mcr Adv	$28	96%
Va Ccn - All Plans	$28	96%
Aetna	$29 - $82	100%
Longevity Health Plan-All Plans	$30	103%
Molina Mcaid - All Plans	$33	114%
Ph Mcaid	$33	114%
Sisco Epi	$47	162%
Sisco-All Other Plans	$47	162%
Blue Cross Blue Shield	$55	189%
Health Alliance Hmo	$63	217%
Asr - All Plans	$66	227%
Health Alliance Ahl - All Other Plans	$66	227%
Cofinity -All Plans	$71	244%
Multiplan - All Plans	$89	306%
UnitedHealthcare	$90 - $102	310%
Benefit Source Inc-All Plans	$92	317%
First Health-All Plans	$92	317%
Usa Managed Care-All Plans	$92	317%
Integrated Health Plans-All Plans	$97	334%
Cigna	$115	396%
Priority Health - All Other Plans	$115	396%
Nomi Health - All Plans	$135	465%

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 $61.
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 Holland Community 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.