CMS Price Transparency Data

Physical therapy (gait training)

Facility: Margaretville Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $155
Cash Discount Price: $222
vs. Medicare Baseline: 5.33x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Margaretville Memorial Hospital is $155. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $222. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.33x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$222

Average discount available for prompt cash payment at this facility.

Insurance Median

$155

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: $222 (764%)

Insurance Median: $155 (533%)

Cash: $222 (764% of Medicare)

Ins. Median: $155 (533% 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 533% of the Medicare baseline (a markup of 433%). 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
Aetna	$98 - $210	337%
Medicare (plans)	$98 - $147	337%
Hamaspik (McR)	$98	337%
Blue Cross Blue Shield	$98 - $169	337%
UnitedHealthcare	$98 - $176	337%
Mvp Gold (McR)	$98	337%
Affinity By Molina McR	$103	354%
Cdphp	$107	368%
Mvp	$122	420%
Oxford	$147 - $165	506%
Emblem Select Care (Exchange)	$154	530%
Magnacare Standard	$155	533%
Emblem Ghi/Hip Ppo/Cbp	$156	537%
Oxford Exchange	$158	544%
Todays Options	$161	554%
Self-Pay	$170	585%
Emblem Ghi/Hip Hmo/Epo/Pos	$181	623%
Multiplan	$182	626%
First Health	$200	688%
Emblem	$230 - $270	791%
Mvp Exchange	$238	819%
Mvp Hmo/Ppo	$280	964%
Magnacare	$390	1342%
Magnacare Preferred	$413	1421%

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 $222.
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 Margaretville 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.