Physical therapy (gait training)
Facility: Western Arizona Regional Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $99
- Cash Discount Price: $112
- vs. Medicare Baseline: 3.41x 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 341% of the Medicare baseline (a markup of 241%). 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 | $25 - $101 | 86% |
| Humana | $28 | 96% |
| Medicare (plans) | $28 | 96% |
| Node Champva | $28 | 96% |
| Node Health Choice Mcr Adv | $28 | 96% |
| Tricare | $28 | 96% |
| Veterans Eval Services | $28 | 96% |
| Healthnet | $29 | 100% |
| Node Non Par Hospice Agree | $29 | 100% |
| Node Triwest | $29 | 100% |
| Node Va | $29 | 100% |
| Aetna | $30 - $418 | 103% |
| Magellan | $30 - $99 | 103% |
| Mercy Care Mcr Adv | $30 | 103% |
| Node Banner Mcr Adv | $30 | 103% |
| Node Devoted Health Mcr Adv | $30 | 103% |
| Onecare | $30 | 103% |
| Node Us Dept Of Labor | $45 | 155% |
| Node Az Complete Health Exchange | $49 | 169% |
| Node Health Choice Integrated Care | $53 | 182% |
| UnitedHealthcare | $71 - $476 | 244% |
| Node Health Choice Health Exchange | $73 | 251% |
| Self Pay | $81 - $142 | 279% |
| Blue Cross Blue Shield | $82 - $135 | 282% |
| Care1St | $99 | 341% |
| Sierra Health Plan | $104 - $406 | 358% |
| Mercy Care | $109 | 375% |
| Health Direct Partners | $271 | 933% |
| Laughlin Healthcare | $271 | 933% |
| Cigna | $293 | 1008% |
| Coventry Work Comp Al | $406 | 1397% |
| Multiplan Primary | $434 | 1493% |
| Multiplan | $467 | 1607% |
| Three Rivers | $576 | 1982% |
| First Health Coventry | $610 | 2099% |