CMS Price Transparency Data

Physical therapy (gait training)

Facility: Southwest Health Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $136
Cash Discount Price: $129
vs. Medicare Baseline: 4.68x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Southwest Health Center is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $129. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.68x the Medicare baseline. Located in 1400 East Side Rd, Platteville, WI.

Cash / Self-Pay

$129

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $129 (444%)

Insurance Median: $136 (468%)

Cash: $129 (444% of Medicare)

Ins. Median: $136 (468% 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 468% of the Medicare baseline (a markup of 368%). 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
Care Wisconsin	$52 - $112	179%
Blue Cross Blue Shield	$52 - $172	179%
UnitedHealthcare	$53 - $141	182%
Quartz	$107 - $134	368%
Dean Health Plan	$123	423%
Cigna	$129	444%
Group Health Cooperative of Sc	$138 - $150	475%
Humana	$155	533%
Healthchoice	$163	561%
Group Health South Central	$172	592%
Group Health Eau Claire	$172	592%
Wps	$430	1480%

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 $129.
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 Southwest Health 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.