CMS Price Transparency Data

Physical therapy (gait training)

Facility: Fostoria Community Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $105
Cash Discount Price: $129
vs. Medicare Baseline: 3.61x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Fostoria Community Hospital is $105. 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 3.61x the Medicare baseline. Located in 501 Van Buren Street, Fostoria, OH.

Cash / Self-Pay

$129

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $105 (361%)

Cash: $129 (444% of Medicare)

Ins. Median: $105 (361% 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 361% of the Medicare baseline (a markup of 261%). 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 - $46	52%
Dayton Area Health Plan Dba Caresource	$15 - $83	52%
Meridian Health Plan Of Mi	$15	52%
UnitedHealthcare	$16 - $119	55%
Blue Cross Blue Shield	$27 - $129	93%
Health Alliance Plan	$27 - $149	93%
Health Value Management	$27 - $43	93%
Paramount Health Care	$27 - $105	93%
Buckeye Community Health Plan Inc	$31 - $72	107%
Aetna	$32 - $133	110%
Veterans Affairs	$44	151%
Amerihealth	$48	165%
Medical Mutual Of Ohio	$112 - $120	385%
Frontpath Health Coalition	$115	396%
Ohio Health Choice	$129	444%
Ohio Ppo Connect	$129 - $149	444%
Health Ohio Network	$157	540%
Connecticut General Life Insurance Company	$159	547%

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 Fostoria Community 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.