CMS Price Transparency Data

Physical therapy (gait training)

Facility: Ira Davenport Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $72
Cash Discount Price: $70
vs. Medicare Baseline: 2.48x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Ira Davenport Memorial Hospital is $72. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.48x the Medicare baseline. Located in 7571 State Route 54, Bath, NY.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$72

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: $70 (241%)

Insurance Median: $72 (248%)

Cash: $70 (241% of Medicare)

Ins. Median: $72 (248% 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 248% of the Medicare baseline (a markup of 148%). 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
Empire	$16	55%
Blue Cross Blue Shield	$25 - $352	86%
Amerihealth Caritas Mcr Adv - All Plans	$28	96%
Humana	$28 - $104	96%
Tricare	$28	96%
Fidelis	$39 - $51	134%
Fidelis Care - Exchange - All Plans	$64	220%
Geisinger - All Plans	$67	231%
Cigna	$72	248%
Mvp Health Plan - All Plans	$72	248%
Independent Health - All Plans	$75	258%
Upmc - All Plans	$80	275%
Pomco Inc - All Plans	$83	286%
Aetna	$87 - $103	299%
UnitedHealthcare	$87 - $122	299%
Emblem Health - All Plans	$102	351%
Emblem/Ghi	$107	368%
Martins Point - All Plans	$116	399%
Healthnow - All Plans	$382	1315%

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 $70.
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 Ira Davenport Memorial 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.