Physical therapy (gait training)
Facility: Good Samaritan Hospital of Suffern
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $225
- Cash Discount Price: $538
- vs. Medicare Baseline: 7.74x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 774% of the Medicare baseline (a markup of 674%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $33 | 114% |
| Hamaspik (McR) | $33 | 114% |
| Mvp Gold (McR) | $33 | 114% |
| Medicare (plans) | $33 - $35 | 114% |
| Affinity By Molina McR | $35 | 120% |
| Beacon Exchange | $39 | 134% |
| Beacon Commercial | $43 | 148% |
| Geisinger Health Commercial/Exchange | $109 | 375% |
| Self-Pay - Cc 30% | $161 | 554% |
| Emblem Select Care (Exchange) | $163 | 561% |
| Blue Cross Blue Shield | $165 - $1,018 | 568% |
| Self-Pay | $182 | 626% |
| Emblem Ghi/Hip Hmo/Epo/Pos | $192 | 661% |
| Emblem Ghi/Hip PPO | $192 | 661% |
| UnitedHealthcare | $193 - $244 | 664% |
| Oxford | $205 - $222 | 705% |
| Oxford Exchange | $207 | 712% |
| Emblem | $230 - $270 | 791% |
| Oxford Commercial | $238 | 819% |
| Mvp | $243 - $286 | 836% |
| Mvp Exchange | $252 | 867% |
| Cdphp | $269 | 926% |
| Self-Pay - Cc 50% | $269 | 926% |
| Mvp Hmo/Ppo | $297 | 1022% |
| Aetna | $339 - $377 | 1167% |
| Magnacare Standard | $377 | 1297% |
| Cigna | $377 | 1297% |
| Magnacare | $390 | 1342% |
| Multiplan | $404 | 1390% |
| PHCS | $404 | 1390% |
| Magnacare Preferred | $413 | 1421% |
| First Health | $457 | 1573% |