CMS Price Transparency Data

Physical therapy (gait training)

Facility: Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $64
Cash Discount Price: $86
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Memorial Hospital is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.20x the Medicare baseline. Located in 715 South Taft Avenue, Fremont, OH.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $86 (296%)

Insurance Median: $64 (220%)

Cash: $86 (296% of Medicare)

Ins. Median: $64 (220% 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 220% of the Medicare baseline (a markup of 120%). 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
Buckeye Community Health Plan	$15 - $212	52%
Caresource	$15 - $212	52%
Health Alliance Plan	$15 - $212	52%
Health Ohio Network	$15 - $148	52%
Medical Mutual Of Ohio	$15 - $89	52%
Meridian Health Plan Of Mi	$15 - $138	52%
Molina Healthcare Of Ohio	$15 - $212	52%
UnitedHealthcare	$15 - $212	52%
Aetna	$16 - $212	55%
Summacare	$26 - $164	89%
Blue Cross Blue Shield	$27 - $212	93%
Frontpath	$27 - $81	93%
Humana	$27 - $138	93%
Paramount Healthcare Inc	$27 - $174	93%
Cigna	$31 - $98	107%
Amerihealth	$37 - $174	127%
Multiplan	$87 - $120	299%

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 $86.
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 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.