CMS Price Transparency Data

Physical therapy (gait training)

Facility: Flushing Hospital Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $33
Cash Discount Price: $71
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Flushing Hospital Medical Center is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.14x the Medicare baseline. Located in 45Th Avenue and Parsons Boulevard, Flushing, NY.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $71 (244%)

Insurance Median: $33 (114%)

Cash: $71 (244% of Medicare)

Ins. Median: $33 (114% 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
UnitedHealthcare	$21 - $202	72%
Ghi	$27 - $33	93%
Healthfirst	$28	96%
Fidelis	$31 - $33	107%
Aetna	$33	114%
Beacon Health Strategies	$33	114%
Centerlight Healthcare	$33	114%
Elderplan	$33	114%
Empire	$33 - $61	114%
Hip	$33 - $64	114%
Humana	$33 - $35	114%
Metroplus	$33 - $36	114%
Vns	$33	114%
Wellcare Of Ny	$34	117%
Senior Whole Health	$35	120%
Elderserve Health	$38	131%
Hamaspik Choice	$38	131%
Magnacare	$38	131%
Centers Plan For Healthy Living	$39	134%
1199 National Benefit Fund	$50	172%
Emblemhealth	$51	175%
Empire Blue Priority	$52	179%
Hotel Trades Council	$61 - $1,912	210%
Cigna	$264	908%

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 $71.
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 Flushing Hospital Medical Center 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.