CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Crouse Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $59
Cash Discount Price: $81
vs. Medicare Baseline: 2.03x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Crouse Hospital is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $81. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.03x the Medicare baseline. Located in 736 Irving Avenue, Syracuse, NY.

Cash / Self-Pay

$81

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $81 (279%)

Insurance Median: $59 (203%)

Cash: $81 (279% of Medicare)

Ins. Median: $59 (203% 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 203% of the Medicare baseline (a markup of 103%). 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
Excellus	$23 - $230	79%
Aetna	$27 - $42	93%
Brighton Healthplan	$27 - $94	93%
Cdphp	$27 - $40	93%
Emblemhealth	$27 - $40	93%
Fidelis	$27 - $212	93%
Humana	$27 - $40	93%
Martins Point	$27 - $40	93%
Mvp	$27 - $212	93%
Nascentia	$27 - $40	93%
UnitedHealthcare	$27 - $235	93%
Mycompass	$28 - $97	96%
Wellcare	$28 - $113	96%
Emblem Health	$60 - $230	206%
Healthfirst Health Plan	$63 - $104	217%
Molina	$63 - $212	217%

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 $81.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97110.

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 97110.
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.