CMS Price Transparency Data

Physical therapy (gait training)

Facility: Community Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $111
Cash Discount Price: $85
vs. Medicare Baseline: 3.82x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Community Memorial Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.82x the Medicare baseline. Located in W180 N8085 Town Hall Rd, Menomonee Falls, WI.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $85 (292%)

Insurance Median: $111 (382%)

Cash: $85 (292% of Medicare)

Ins. Median: $111 (382% 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 382% of the Medicare baseline (a markup of 282%). 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
Allwell	$28	96%
Blue Cross Blue Shield	$28 - $329	96%
Community Care	$28	96%
Health Partners	$28 - $117	96%
Humana	$28	96%
Icare	$28	96%
Network Health Plan	$28 - $263	96%
Security Health Plan	$28	96%
UnitedHealthcare	$28 - $370	96%
Aetna	$29 - $126	100%
Care Wisconsin/Mychoice	$29	100%
Centivo	$38 - $59	131%
Froedtert South	$54 - $76	186%
Chorus Community Health Plan	$55 - $77	189%
Common Ground	$77 - $108	265%
Trilogy	$88 - $124	303%
Health Payment Systems	$89 - $125	306%
Wisconsin Physician Services	$90 - $126	310%
Aspirus	$102 - $144	351%
Ibsi Passport	$104 - $146	358%
Americas Choice	$111 - $157	382%
Federated Mutual	$111 - $157	382%
Healtheos	$111 - $157	382%
Multiplan/Private Healthcare Systems	$111 - $157	382%
Savility	$111 - $157	382%
Cigna	$113 - $158	389%
First Health Network	$113 - $158	389%
Healthsmart	$115 - $162	396%
Physicians Plus	$115 - $162	396%
Sheboygan Employers Health Network	$294	1012%

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 $85.
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 Community 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.