CMS Price Transparency Data
Physical therapy (gait training)
Facility: Mount Carmel Dublin
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $68
- Cash Discount Price: $94
- vs. Medicare Baseline: 2.34x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mount Carmel Dublin is $68. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.34x the Medicare baseline. Located in 4105 Emerald Pkwy, Dublin, OH.
Cash / Self-Pay
$94
Average discount available for prompt cash payment at this facility.
Insurance Median
$68
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: $94 (323%)
Insurance Median: $68 (234%)
Cash: $94 (323% of Medicare)
Ins. Median: $68 (234% 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 234% of the Medicare baseline (a markup of 134%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $25 - $29 | 86% |
| Aetna | $27 - $96 | 93% |
| Blue Cross Blue Shield | $27 - $145 | 93% |
| UnitedHealthcare | $28 - $283 | 96% |
| The Health Plan | $29 | 100% |
| Oscar | $46 | 158% |
| Medical Mutual | $51 - $74 | 175% |
| Enterprise Group Planning | $54 | 186% |
| Custom Design Benefits | $59 | 203% |
| Quality Care Partners | $63 | 217% |
| Geha | $65 - $283 | 224% |
| Gravie Admin Services | $65 | 224% |
| Healthez | $65 | 224% |
| Meritain | $65 | 224% |
| Webtpa | $65 | 224% |
| Access Health | $68 | 234% |
| Acclaim | $68 | 234% |
| Administrative Concepts | $68 | 234% |
| Allegeant | $68 | 234% |
| Allied Benefit Systems | $68 | 234% |
| American Family | $68 | 234% |
| American Healthcare Alliance | $68 | 234% |
| American National | $68 | 234% |
| American Republic | $68 | 234% |
| Amerihealth | $68 | 234% |
| Aultcare | $68 | 234% |
| Automated Benefit Services | $68 | 234% |
| Auxiant | $68 | 234% |
| Benefit Administrative Systems,Llc | $68 | 234% |
| Boon Chapman | $68 | 234% |
| Cam Administrative Services | $68 | 234% |
| Christian Brother Services | $68 | 234% |
| Christian Brothers Holy Cross | $68 | 234% |
| Claimchoice Adminstrators | $68 | 234% |
| Comprehensive Benefits | $68 | 234% |
| Continental Life Insurance | $68 | 234% |
| Coventry | $68 | 234% |
| Custom Benefit Administrators | $68 | 234% |
| Cypress Benefit Administrators | $68 | 234% |
| Employee Benefit Concepts | $68 | 234% |
| Employee Benefit Management | $68 | 234% |
| Forest County Potawatomi | $68 | 234% |
| Freedom Life Insurance Company | $68 | 234% |
| Group Administrators | $68 | 234% |
| Group Marketing Services | $68 | 234% |
| Group Pension Administrators | $68 | 234% |
| Guardian | $68 | 234% |
| Health America | $68 | 234% |
| Health Choices | $68 | 234% |
| Healthcare Management Admin | $68 | 234% |
| Insight | $68 | 234% |
| Intercare | $68 | 234% |
| Jfp Benefit Management | $68 | 234% |
| Jp Farley Corporation | $68 | 234% |
| Key Benefit Administrator | $68 | 234% |
| Liberty Union Life Assurance Co | $68 | 234% |
| Lucent Health | $68 | 234% |
| Luminare Health | $68 | 234% |
| Magnacare | $68 | 234% |
| Medcost | $68 | 234% |
| Mutual Health Services | $68 | 234% |
| Mutual Of Omaha | $68 | 234% |
| Ncas | $68 | 234% |
| Nippon Life Ins | $68 | 234% |
| Nova | $68 | 234% |
| Painters Union Insurance Fund | $68 | 234% |
| Physicians Mutual | $68 | 234% |
| Plumbers Local 98 Insurance Fund | $68 | 234% |
| Prairie States | $68 | 234% |
| Preferred One | $68 | 234% |
| Primary Physician Care | $68 | 234% |
| Professional Benefit Administrators | $68 | 234% |
| Secureone Preferred United Plans | $68 | 234% |
| Siho Insurance Services | $68 | 234% |
| Sisco Benefits | $68 | 234% |
| The Loomis Company | $68 | 234% |
| Trustmark Small Business Benefits | $68 | 234% |
| U Of M Health Plan | $68 | 234% |
| Unicare | $68 | 234% |
| Unified Group Services | $68 | 234% |
| Us Health And Life | $68 | 234% |
| Valenz | $68 | 234% |
| Varipro | $68 | 234% |
| Wps | $68 | 234% |
| Humana | $74 - $145 | 255% |
| Western & Southern Financial Group | $74 | 255% |
| First Health | $76 | 262% |
| Paramount Hmo | $76 | 262% |
| Medben | $87 - $109 | 299% |
| Consociate | $89 | 306% |
| Health Ohio Network | $89 | 306% |
| Rural Carrier Health Benefit Plan | $96 | 330% |
| Healthlink Inc | $109 | 375% |
| Medical Benefits Mutual | $109 | 375% |
| Ohio Health Choice | $109 | 375% |
| Ohio Ppo Connect | $109 | 375% |
| Ameriben | $116 | 399% |
| Luminare Health (Detroit) | $116 | 399% |
| Medi Share | $116 | 399% |
| Multiplan | $116 | 399% |
| Ohiohealthy | $116 | 399% |
| Osu Not Independent Choice | $116 | 399% |
| Phcs | $116 | 399% |
| Philadelphia American Life Insurance | $116 | 399% |
| Twin Valley Psychiatric | $116 | 399% |
| Health Smart | $123 | 423% |
| Medicaid / KanCare | $145 | 499% |
| American Postal Workers Secondary | $232 | 798% |
| Cigna | $232 | 798% |
| Health Partners | $232 | 798% |
| Healthgram | $232 | 798% |
| Mvp | $232 | 798% |
| Priority Health | $232 | 798% |