CMS Price Transparency Data

Physical therapy (gait training)

Facility: South Pointe Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $97
Cash Discount Price: $137
vs. Medicare Baseline: 3.34x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at South Pointe Hospital is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.34x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$137

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $137 (471%)

Insurance Median: $97 (334%)

Cash: $137 (471% of Medicare)

Ins. Median: $97 (334% 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 334% of the Medicare baseline (a markup of 234%). 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
UnitedHealthcare	$28 - $131	96%
Paramount	$30	103%
Blue Cross Blue Shield	$31 - $136	107%
Buckeye	$31	107%
Molina	$31	107%
Amerihealth	$32	110%
Caresource	$32	110%
United	$32 - $238	110%
Aetna	$37 - $211	127%
Humana	$37 - $179	127%
Summacare	$37 - $79	127%
The Health Plan	$37 - $127	127%
Upmc	$37 - $127	127%
Valor	$37	127%
Cigna	$38 - $169	131%
Perennial Health	$40	138%
Oscar	$64 - $81	220%
Cc Ehp	$84 - $85	289%
Aultcare	$91	313%
Ohcp	$103	354%
Omas	$106	365%
Mmo	$113 - $127	389%
Ohio Healthy	$114	392%
Healthsmart	$116	399%
Php	$127	437%
Gms	$148	509%
Medical Benefit Corp	$148	509%
Quality Care Partners	$148	509%
Consociate Health	$158	544%
Frontpath	$190	654%
Managed Care Services	$190	654%
Multiplan	$190	654%
Tertiary Care Network	$190	654%
Three Rivers	$190	654%

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 $137.
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 South Pointe 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.