CMS Price Transparency Data

Physical therapy (gait training)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $105
Cash Discount Price: $134
vs. Medicare Baseline: 3.61x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at UPMC Children's Hospital of Pittsburgh is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.61x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$134

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: $134 (461%)

Insurance Median: $105 (361%)

Cash: $134 (461% 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
Upmc Health Plan	$19 - $86	65%
Aetna	$22 - $123	76%
Amerihealth Caritas	$31	107%
Health Partners Plans (Jefferson Health Plan)	$32	110%
UnitedHealthcare	$33 - $105	114%
Geisinger	$34 - $101	117%
Highmark Wholecare (Prev Gateway)	$34	117%
Pa Health & Wellness	$34	117%
Blue Cross Blue Shield	$73 - $112	251%
Cigna	$105 - $123	361%
Health Plan Of Upper Ohio Valley	$146	502%
Intergroup	$146 - $190	502%
Coventry/First Health	$179	616%
Saudi Armed Forces	$179	616%
Health Payors Organization	$190	654%
Multiplan	$190	654%
National Provider Network	$202	695%
Private Health Care Systems	$202	695%

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 $134.
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 UPMC Children's Hospital of Pittsburgh 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.