Physical therapy (gait training)
Facility: Baldwin Health
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $42
- Cash Discount Price: $97
- vs. Medicare Baseline: 1.45x 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.
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 |
|---|---|---|
| First Choice | $15 | 52% |
| Medicaid / KanCare | $20 | 69% |
| Tricare | $25 | 86% |
| Blue Cross Blue Shield | $27 - $45 | 93% |
| Cigna | $27 - $132 | 93% |
| Community Hospice | $27 | 93% |
| Hospice | $27 | 93% |
| Humana | $27 | 93% |
| Medicare (plans) | $27 | 93% |
| Mercy Medical Hospice | $27 | 93% |
| Node Champva | $27 | 93% |
| Node Clover Health Mcr Adv | $27 | 93% |
| Node Devoted Health Mcr Adv | $27 | 93% |
| Node Va | $27 | 93% |
| Select Health | $27 | 93% |
| Triwest | $27 | 93% |
| UnitedHealthcare | $27 - $248 | 93% |
| Veterans Eval Services | $27 | 93% |
| Windsor Health Plan | $27 | 93% |
| Aetna | $28 - $362 | 96% |
| Node Wellcare Mcr Adv | $28 | 96% |
| Multiplan Inc | $36 | 124% |
| Alamed | $37 | 127% |
| Ambetter / Centene | $41 | 141% |
| First Health | $42 - $302 | 145% |
| Novanet | $42 | 145% |
| Us Dol | $42 | 145% |
| Self Pay | $72 - $121 | 248% |
| American Employee Alliance | $161 | 554% |
| Multiplan | $230 - $330 | 791% |
| Coventry Work Comp Al | $315 | 1084% |
| One Health | $322 | 1108% |
| Pro America | $322 | 1108% |
| Alabama Wc | $342 | 1177% |
| Gulf Health | $342 | 1177% |
| Principal Ppo | $342 | 1177% |
| Viva Health | $342 | 1177% |
| National Health | $362 | 1246% |
| Galaxy | $366 | 1259% |