CMS Price Transparency Data

Physical therapy (gait training)

Facility: Crouse Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $27
Cash Discount Price: $78
vs. Medicare Baseline: 0.93x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Crouse Hospital is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 0.93x the Medicare baseline. Located in 736 Irving Avenue, Syracuse, NY.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$27

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: $78 (268%)

Insurance Median: $27 (93%)

Cash: $78 (268% of Medicare)

Ins. Median: $27 (93% 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
Brighton Healthplan	$22 - $27	76%
Excellus	$22 - $230	76%
Fidelis	$22 - $50	76%
Healthfirst Health Plan	$22 - $25	76%
Molina	$22 - $50	76%
UnitedHealthcare	$22 - $235	76%
Wellcare	$22 - $28	76%
Mycompass	$23 - $28	79%
Aetna	$27 - $42	93%
Cdphp	$27	93%
Emblemhealth	$27	93%
Humana	$27	93%
Martins Point	$27	93%
Mvp	$27 - $56	93%
Nascentia	$27	93%
Emblem Health	$60 - $230	206%

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 $78.
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 Crouse 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.