Physical therapy (gait training)
Facility: Saint John Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $28
- Cash Discount Price: $27
- vs. Medicare Baseline: 0.96x 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 |
|---|---|---|
| Blue Cross Blue Shield | $22 - $46 | 76% |
| Medicaid / KanCare | $24 | 83% |
| UnitedHealthcare | $24 - $39 | 83% |
| Celtic | $25 - $139 | 86% |
| Healthy Blue | $25 - $29 | 86% |
| Cigna | $28 | 96% |
| Medicare (plans) | $28 | 96% |
| Kansas Superior Select | $28 | 96% |
| Aetna | $28 - $42 | 96% |
| Tricare | $28 | 96% |
| Midland Care Connection | $28 | 96% |
| Corizon | $39 | 134% |
| Well Path | $39 | 134% |
| Employer Direct Healthcare | $39 | 134% |
| Centurion | $41 | 141% |
| Naphcare | $43 | 148% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Saint John Hospital in Leavenworth, KS, the facility's cash median rate is $27.00, which is notably lower than the state average of $29.06. While the hospital's negotiated rates with various payers range from $22 to $46, patients with high-deductible plans may find paying the cash price directly more cost-effective, as the cash rate is significantly below the lowest negotiated amount of $22.00. It is important to note that commercial rates often include administrative overhead and contract premiums that can inflate the final price compared to the direct cash cost.
To ensure you are not overcharged, we recommend requesting a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, you should inquire about "self-pay" or "prompt-pay" discounts, which can reduce the total bill by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims processing. If you receive a balance bill for the difference between the provider's chargemaster and your insurance allowed amount, you may be protected under the No Surprises Act for non-emergency services at in-network facilities, and you should dispute any unexpected charges in writing rather than accepting summary invoices.