Physical therapy (gait training)
Facility: University Of Kansas Health System - St Francis Campus
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $70
- Cash Discount Price: $51
- vs. Medicare Baseline: 2.41x 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 241% of the Medicare baseline (a markup of 141%). 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 |
|---|---|---|
| Hooray Health [8000] | $70 | 241% |
| Black Lung [6055] | $70 | 241% |
| Web Tpa [2115] | $70 | 241% |
| Aetna | $70 | 241% |
| Blue Cross Blue Shield | $70 | 241% |
| Lucent Health [6000] | $70 | 241% |
| Healthcare Highways [2210] | $70 | 241% |
| Oncology Patient Assistance Programs [2295] | $70 | 241% |
| Department Of Corrections [1340] | $86 | 296% |
| National Association Of Letter Carriers [1695] | $99 | 341% |
| Cigna | $99 | 341% |
| American Postal Workers Union [1070] | $99 | 341% |
| Healthpartners [1500] | $99 | 341% |
| Humana | $101 | 348% |
| Administrative Concepts [1005] | $133 | 458% |
| American Healthcare [1055] | $133 | 458% |
| First Health [1375] | $133 | 458% |
| Multiplan [1680] | $133 | 458% |
| Coventry Healthcare [1320] | $140 | 482% |
| Ks Disability Determination [6090] | $171 | 588% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, Physical therapy (gait training), the University Of Kansas Health System - St Francis Campus in Topeka, KS, lists a gross charge of $171.00. This amount is significantly higher than the state average, which is $29.06 according to Medicare benchmarking data. While the facility offers a cash median price of $51.00, commercial insurance plans typically negotiate rates that average $70.00, which is still double the cash price. Patients with high-deductible plans or those who have already met their out-of-pocket maximum may find that paying the cash rate of $51.00 directly is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overhead and contract structures.
To minimize unexpected costs, patients should verify their specific plan's negotiated rate before scheduling, as in-network rates vary widely across different carriers. If a patient chooses to pay out-of-pocket, they should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final amount by 20% to 50% if paid in full upfront. It is also important to request an itemized bill to ensure no errors exist, as over 80% of hospital bills contain mistakes such as double-billing or unbundled codes. Finally, if a patient receives a balance bill from an out-of-network provider at this in-network facility, they should not pay immediately; instead, they should dispute the charge with their insurer to invoke federal protections under the No Surprises Act.