CMS Price Transparency Data

Physical therapy (gait training)

Facility: The University of Vermont Health Network-Alice Hy

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $41
Cash Discount Price: $109
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at The University of Vermont Health Network-Alice Hy is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $109. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.41x the Medicare baseline. Located in 133 Park Street, Po Box 729, Malone, NY.

Cash / Self-Pay

$109

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $109 (375%)

Insurance Median: $41 (141%)

Cash: $109 (375% of Medicare)

Ins. Median: $41 (141% 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
Blue Cross Blue Shield	$31 - $90	107%
Aetna	$35 - $94	120%
Capital District Physicians' Health Plan	$35 - $102	120%
Choicecare	$35 - $82	120%
Fidelis Care	$35 - $92	120%
Humana	$35	120%
Martins Point	$35	120%
Mvp	$35 - $90	120%
St. Regis	$35	120%
UnitedHealthcare	$35 - $484	120%
Veterans Affairs Community Care Network	$35	120%
Magnacare	$87	299%
Highmark Blueshield	$98	337%

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 $109.
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 The University of Vermont Health Network-Alice Hy 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.