CMS Price Transparency Data

Physical therapy (gait training)

Facility: Kaleida Health

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $35
Cash Discount Price: $141
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Kaleida Health is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $141. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.20x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$141

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $141 (485%)

Insurance Median: $35 (120%)

Cash: $141 (485% of Medicare)

Ins. Median: $35 (120% 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.

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
Independent Health Association	$16 - $45	55%
Independent Health Association - Wchob	$17 - $46	58%
Blue Cross Blue Shield	$19 - $105	65%
Tricare	$27	93%
Univera	$28 - $66	96%
Wellcare	$29	100%
Aetna	$30 - $35	103%
Fidelis	$31	107%
UnitedHealthcare	$31	107%
Cigna	$33 - $40	114%
Ghi/Emblem Health	$34 - $42	117%
Ghi/Emblem Health - Wchob	$34 - $42	117%
Magnacare	$35 - $45	120%
Magnacare - Wchob	$35 - $45	120%
Univera - Wchob	$38 - $66	131%

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 $141.
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 Kaleida Health 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.