CMS Price Transparency Data

Physical therapy (gait training)

Facility: Marshfield Medical Center - Beaver Dam (Mmc-Bd)

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $104
Cash Discount Price: $116
vs. Medicare Baseline: 3.58x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Marshfield Medical Center - Beaver Dam (Mmc-Bd) is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.58x the Medicare baseline. Located in 707 S University Ave, Beaver Dam, WI.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $116 (399%)

Insurance Median: $104 (358%)

Cash: $116 (399% of Medicare)

Ins. Median: $104 (358% 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 358% of the Medicare baseline (a markup of 258%). 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
The Alliance	$62	213%
Security Health Plan (Shp)	$63 - $70	217%
Amish/Mennonite	$67	231%
Quartz	$70	241%
Wps Health Insurance	$82 - $84	282%
Cigna	$83 - $90	286%
Health Payment Systems	$85	292%
Humana	$96 - $109	330%
Group Health Cooperative Of Eau Claire	$100 - $116	344%
Network Health Plan	$102	351%
First Health	$104	358%
Molina Healthcare Of Wi	$104	358%
Trilogy	$110	379%
Healtheos By Multiplan Inc.	$113 - $116	389%
Health Partners	$116	399%
Coventry	$117	403%
UnitedHealthcare	$253	871%
Blue Cross Blue Shield	$318 - $477	1094%

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 $116.
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 Marshfield Medical Center - Beaver Dam (Mmc-Bd) 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.