CMS Price Transparency Data

Physical therapy (gait training)

Facility: NYU Langone Hospitals

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $239
Cash Discount Price: $66
vs. Medicare Baseline: 8.22x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at NYU Langone Hospitals is $239. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 8.22x the Medicare baseline. Located in 550 First Avenue, New York, NY.

Cash / Self-Pay

$66

Average discount available for prompt cash payment at this facility.

Insurance Median

$239

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: $66 (227%)

Insurance Median: $239 (822%)

Cash: $66 (227% of Medicare)

Ins. Median: $239 (822% 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 822% of the Medicare baseline (a markup of 722%). 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
Fidelis	$30 - $256	103%
Healthfirst	$30 - $256	103%
Healthplus	$30 - $256	103%
Ghi	$32 - $360	110%
Hip	$32 - $360	110%
Medicare (plans)	$32 - $33	110%
Wellcare	$32 - $33	110%
Amida	$33	114%
Centerlight	$33	114%
Metroplus	$45 - $256	155%
Hamaspik	$48 - $49	165%
1199	$50	172%
Medicaid / KanCare	$70 - $114	241%
UnitedHealthcare	$70 - $381	241%
Somos	$73 - $154	251%
Blue Cross Blue Shield	$191 - $239	657%
Oscar	$239	822%
Multiplan	$269	926%
Oxford	$308 - $358	1060%
Aetna	$313 - $345	1077%
Magnacare	$370 - $596	1273%
Cigna	$393	1352%

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 $66.
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 NYU Langone Hospitals 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.