Physical therapy (gait training)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $27
- Cash Discount Price: $43
- vs. Medicare Baseline: 0.93x 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 |
|---|---|---|
| Medica Contracted [320239] | $24 | 83% |
| Medicaid / KanCare | $24 - $27 | 83% |
| Blue Cross Blue Shield | $24 - $56 | 83% |
| UnitedHealthcare | $25 - $44 | 86% |
| Aetna | $26 - $56 | 89% |
| Tricare | $26 | 89% |
| Humana | $26 - $27 | 89% |
| Kindful Hospice Contracted [320434] | $27 | 93% |
| Elara Caring Aspire Hospice [20433] | $27 | 93% |
| Dept Of Veteran Affairs Contracted [320106] | $27 | 93% |
| Mercy Hospice Okc [20252] | $27 | 93% |
| Halo Hcr Inc Hospice Contracted [320432] | $27 | 93% |
| Halo Hcr Inc Hospice [20432] | $27 | 93% |
| Medicare (plans) | $27 | 93% |
| Cross Timbers Hospice [20098] | $27 | 93% |
| Pace Of The Ozarks Contracted [320518] | $27 | 93% |
| Kindful Hospice [20434] | $27 | 93% |
| Ambetter / Centene | $27 | 93% |
| Home State Health Plan Contracted [320187] | $27 | 93% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $28 | 96% |
| United Medical Resources Contracted [320454] | $44 | 151% |
| Health Choice Contracted [320166] | $45 | 155% |
| Cigna | $46 - $51 | 158% |
| Providrs Care Network Contracted [320484] | $52 | 179% |
| Edison Health Solutions Contracted [320502] | $53 | 182% |
| Yuzu Health Contracted [320521] | $53 | 182% |
| Auxiant Contracted [320462] | $53 | 182% |
| American Healthcare Alliance Contracted [320020] | $53 | 182% |
| Mercy Benefit Admin Contracted [320251] | $53 | 182% |
| Reflect Health Contracted [320492] | $53 | 182% |
| Healthlink Contracted [320179] | $53 | 182% |
| Aither Health Contracted [320449] | $53 | 182% |
| Imagine 360 Contracted [320494] | $53 | 182% |
| Workers Comp [20426] | $53 | 182% |
| Ebms Contracted [320493] | $53 | 182% |
| First Health Contracted [320128] | $56 | 193% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Mercy Hospital Pittsburg, Inc. lists a gross charge of $66.00. When compared to the Medicare benchmark rate of $29.06, the facility's gross charge is approximately 227% of the federal baseline, which aligns with the typical commercial markup range of 200% to 300% observed in the healthcare industry. While the facility's cash median price is $43.00, this amount remains higher than the Medicare rate, illustrating that for patients with high-deductible plans, paying cash directly might still be more cost-effective than relying on insurance, as commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures.
The data reveals significant variation in what different payers will cover, with negotiated rates ranging from a low of $24 to a high of $56 across 36 different payers. Notably, many commercial plans, including UnitedHealthcare, Aetna, and various managed care networks, have negotiated rates between $26 and $56, which are substantially higher than the facility's cash price of $43.00. This disparity highlights the importance of verifying your specific plan's negotiated rate before scheduling, as assuming that being in-network guarantees the lowest possible price can lead to unexpected costs. Patients are encouraged to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the higher administrative costs associated with insurance billing cycles.