CMS Price Transparency Data

Physical therapy (gait training)

Facility: Fort Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $116
Cash Discount Price: $54
vs. Medicare Baseline: 3.99x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Fort Memorial Hospital is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.99x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $54 (186%)

Insurance Median: $116 (399%)

Cash: $54 (186% of Medicare)

Ins. Median: $116 (399% 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 399% of the Medicare baseline (a markup of 299%). 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
Blue Cross Blue Shield	$12 - $271	41%
Dean Health Plan	$12 - $117	41%
Medicaid / KanCare	$12	41%
Quartz	$12 - $157	41%
UnitedHealthcare	$12 - $136	41%
Managed Health Services	$13	45%
Humana	$29 - $128	100%
Molina	$30	103%
Veteran Evaluation Services	$46	158%
Aetna	$63 - $134	217%
Fort Care	$90	310%
Group Health Cooperative	$100 - $261	344%
Alliance	$111 - $129	382%
Mercycare	$116 - $133	399%
Trilogy	$137 - $157	471%
Cigna	$148 - $170	509%
Centivo	$288 - $300	991%

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 $54.
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 Fort Memorial 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.