Physical therapy (gait training)
Facility: Ascension Via Christi Hospitals Wichita, Inc.
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $28
- Cash Discount Price: Unavailable
- 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 |
|---|---|---|
| Va | $27 | 93% |
| Saint Lukes Health Systems | $27 | 93% |
| Via Christi Research | $27 | 93% |
| Humana | $27 | 93% |
| Medicare (plans) | $27 - $28 | 93% |
| Vc Hope | $27 | 93% |
| UnitedHealthcare | $28 - $77 | 96% |
| Blue Cross Blue Shield | $28 | 96% |
| Corizon | $34 | 117% |
| Smarthealth | $38 | 131% |
| Medicaid / KanCare | $46 | 158% |
| Coventry City Of Wichita | $64 | 220% |
| Mdsave | $70 | 241% |
| Aetna | $92 | 317% |
Consumer Guidance & Cost Commentary
For CPT code 97116, Physical therapy (gait training), at Ascension Via Christi Hospitals Wichita, Inc., the facility's negotiated rates range from $27 to $92 depending on the payer. The lowest negotiated rate is $27, which matches the rates for several major payers including Va, Saint Lukes Health Systems, and Humana. However, the highest negotiated rate is $92 for Aetna, while UnitedHealthcare ranges from $28 to $77. The facility's median negotiated rate is $28.00, which is slightly higher than the Medicare benchmark of $29.06 (a ratio of 1.0). This indicates that the facility's pricing is aligned with the federal government's cost-based standard rather than exceeding typical commercial markups.
Patients should be aware that cash-pay options may offer significant savings compared to insurance negotiated rates, particularly if a patient has a high deductible or no active coverage. While the data does not list a specific cash price, the facility is a voluntary non-profit located in Wichita, KS (Zip 67214), and may offer prompt-pay discounts for upfront payment. To secure the best possible rate, patients should explicitly request a self-pay or prompt-pay classification before check-in and sign a waiver of insurance submission to avoid automatic claims processing. It is also advisable to review any itemized bill for errors, as over 80% of hospital bills contain mistakes such as unbundled codes or services not rendered, which can be corrected through a formal written audit dispute.