Physical therapy (gait training)
Facility: Grandview Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $153
- Cash Discount Price: $66
- vs. Medicare Baseline: 5.26x 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 526% of the Medicare baseline (a markup of 426%). 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 |
|---|---|---|
| Medicaid / KanCare | $20 | 69% |
| Tricare | $25 | 86% |
| Blue Advantage | $27 | 93% |
| Cigna | $27 - $171 | 93% |
| Hospice | $27 | 93% |
| Humana | $27 | 93% |
| Medicare (plans) | $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% |
| UnitedHealthcare | $27 - $217 | 93% |
| Veterans Eval Services | $27 | 93% |
| Victory Health | $27 | 93% |
| Viva Health | $27 - $191 | 93% |
| Aetna | $28 - $96 | 96% |
| Node Wellcare Mcr Adv | $28 | 96% |
| Alamed | $35 | 120% |
| Ambetter / Centene | $41 | 141% |
| First Health | $41 - $208 | 141% |
| Node Us Dept Of Labor | $42 | 145% |
| Novanet | $42 | 145% |
| Healthspring | $48 | 165% |
| Self Pay | $50 - $83 | 172% |
| Blue Cross Blue Shield | $56 | 193% |
| Bp Health Advocate | $83 - $87 | 286% |
| Ag Administrators | $116 - $121 | 399% |
| Choicecare | $116 - $121 | 399% |
| Drummond | $116 - $121 | 399% |
| American Employee Alliance | $133 - $139 | 458% |
| Healthchoice | $166 - $208 | 571% |
| Value Options | $166 - $174 | 571% |
| Multiplan | $203 - $243 | 699% |
| Blue Bell Creameries | $232 - $243 | 798% |
| Natl Comp Care | $249 - $260 | 857% |
| Usa Ppo | $249 - $260 | 857% |
| Coventry Work Comp Al | $260 - $271 | 895% |
| Alabama Wc | $282 - $295 | 970% |
| Cal-Med | $282 - $295 | 970% |
| Corvel | $282 - $295 | 970% |
| Associated Admin | $299 - $312 | 1029% |