Physical therapy (gait training)
Facility: Stormont Vail Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $44
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.51x 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 | $25 - $72 | 86% |
| UnitedHealthcare | $25 | 86% |
| Ambetter / Centene | $25 | 86% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Stormont Vail Hospital in Topeka, KS, has a gross charge of $212.00. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $25.00 to $72.00, the median amount paid by insurance is $13,780.00, which is significantly higher than the cash price. It is important to note that cash-pay rates are not listed for this service, but patients with high-deductible plans should be aware that paying out-of-pocket can sometimes be cheaper if the insurance negotiated rate exceeds the cash price. Since the facility is an acute care hospital in a voluntary non-profit setting, patients are encouraged to contact the billing department directly to inquire about self-pay or prompt-pay discounts before scheduling treatment.
This service is benchmarked against the Medicare rate of $29.06, showing a ratio of 1.5 times the Medicare amount. The facility's location in Topeka, KS (ZIP 66604), places it within a specific geographic context where commercial rates often differ from federal benchmarks. If you receive a bill for this service, you should request a full itemized CPT-coded statement rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Furthermore, if you are an out-of-network patient receiving care at this in-network facility, the No Surprises Act generally protects you from balance billing for emergency and non-emergency services, so you should dispute any unexpected charges immediately rather