CMS Price Transparency Data

Physical therapy (gait training)

Facility: Christ Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $80
Cash Discount Price: $86
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Christ Hospital is $80. 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 2.75x the Medicare baseline. Located in 2139 Auburn Avenue, Cincinnati, OH.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $80 (275%)

Cash: $86 (296% of Medicare)

Ins. Median: $80 (275% 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 275% of the Medicare baseline (a markup of 175%). 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
Aetna	$34 - $86	117%
Allied Benefits [2163]	$34	117%
First Health [2041]	$34	117%
Meritain Health [2224]	$34	117%
Humana	$36 - $86	124%
Kentucky Passport/Molina [2097]	$36	124%
Medicaid / KanCare	$36 - $86	124%
UnitedHealthcare	$36 - $170	124%
Wellcare Of Kentucky [2191]	$36	124%
Blue Cross Blue Shield	$49 - $86	169%
Caresource [2031]	$49 - $86	169%
Medben [2222]	$68 - $80	234%
Ohio Health Choice [2062]	$69	237%
Other Exchange Plan [9992]	$69 - $144	237%
Cigna	$77 - $144	265%
Nalc [2178]	$77	265%
Priority Health [2225]	$77	265%
Amerihealth Caritas [2230]	$86	296%
Buckeye Community Health [2028]	$86	296%
Life Synch [2080]	$86	296%
Multiplan/Phcs [2059]	$105	361%
Bccp [3079]	$144	496%
Healthcare Highways [2298]	$144	496%
Sagamore Health Network [2066]	$144	496%
Suburban Health [2408]	$144	496%
Geha [2168]	$170	585%
Golden Rule [2161]	$170	585%
United Medical Resources [2104]	$170	585%

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 Christ 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.