CMS Price Transparency Data

Physical therapy (gait training)

Facility: Tomah Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $48
Cash Discount Price: $82
vs. Medicare Baseline: 1.65x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Tomah Memorial Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.65x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $82 (282%)

Insurance Median: $48 (165%)

Cash: $82 (282% of Medicare)

Ins. Median: $48 (165% 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.

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	$48 - $131	165%
Group Hlth Mcr Adv - All Plans	$48	165%
Humana	$48 - $132	165%
Independent Care Mcaid	$48	165%
Independent Care Mcr - All Other Plans	$48	165%
Managed Hlth Mcaid - All Plans	$48	165%
Quartz Mcaid	$48	165%
Quartz Mcr Adv	$48	165%
Security Hp Mcaid	$48	165%
Security Hp Mcr Adv	$48	165%
UnitedHealthcare	$48 - $134	165%
Va Ccn - All Plans	$48	165%
Aetna	$93 - $121	320%
Cigna	$108 - $138	372%
Security Hp Comm - All Other Plans	$121	416%
Quartz Comm - All Other Plans	$128	440%
The Alliance - All Plans	$133	458%

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 $82.
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 Tomah 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.