CMS Price Transparency Data

Physical therapy (gait training)

Facility: Cheshire Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $65
Cash Discount Price: $52
vs. Medicare Baseline: 2.24x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Cheshire Medical Center is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.24x the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$52

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $52 (179%)

Insurance Median: $65 (224%)

Cash: $52 (179% of Medicare)

Ins. Median: $65 (224% 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 224% of the Medicare baseline (a markup of 124%). 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
Amerihealth Caritas Nh	$21 - $23	72%
Granite State Health Plan	$21 - $32	72%
Wellsense Health Plan	$21 - $31	72%
Aetna	$29 - $129	100%
Ambetter / Centene	$29 - $31	100%
Blue Cross Blue Shield	$29 - $150	100%
Cigna	$29 - $94	100%
Martin'S Point Generations Advantage	$29 - $31	100%
Mass General Brigham Health Plan	$29 - $189	100%
Mvp	$29 - $94	100%
UnitedHealthcare	$29 - $143	100%
Wellcare Health Plans	$29 - $31	100%
Martin'S Point Health Care	$30 - $31	103%
Harvard Pilgrim Health Care Of Ne	$40 - $86	138%
Tufts Health Plan	$83 - $121	286%
Maine Community Health Options	$85	292%
First Health/Hcvm	$161	554%
Phcs	$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 $52.
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 Cheshire 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.