CMS Price Transparency Data

Physical therapy (gait training)

Facility: Memorial Hospital for Cancer and Allied Diseases

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $222
Cash Discount Price: $351
vs. Medicare Baseline: 7.64x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Memorial Hospital for Cancer and Allied Diseases is $222. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $351. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 7.64x the Medicare baseline. Located in 1275 York Ave, New York, NY.

Cash / Self-Pay

$351

Average discount available for prompt cash payment at this facility.

Insurance Median

$222

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: $351 (1208%)

Insurance Median: $222 (764%)

Cash: $351 (1208% of Medicare)

Ins. Median: $222 (764% 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 764% of the Medicare baseline (a markup of 664%). 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
Emblem	$30 - $271	103%
Healthfirst	$60 - $211	206%
Fidelis	$67 - $81	231%
Aetna	$130 - $734	447%
Empire	$219 - $274	754%
Magnacare	$225 - $281	774%
Metroplus	$228	785%
Urn	$249	857%
6 Degrees Health	$274	943%
Multiplan	$316	1087%
Cigna	$546	1879%
Oxford	$666 - $826	2292%
UnitedHealthcare	$881	3032%

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 $351.
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 Memorial Hospital for Cancer and Allied Diseases 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.