Physical therapy (gait training)
Facility: Wesley Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $37
- Cash Discount Price: $608
- vs. Medicare Baseline: 1.27x 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 |
|---|---|---|
| Humana | $24 - $28 | 83% |
| Devoted Health | $24 - $28 | 83% |
| Aetna | $24 - $217 | 83% |
| UnitedHealthcare | $24 | 83% |
| Coventry Health Care | $24 - $28 | 83% |
| United | $25 - $274 | 86% |
| Medicaid / KanCare | $25 | 86% |
| Ambetter / Centene | $25 - $109 | 86% |
| Amerigroup | $25 | 86% |
| Triwest Health Alliance | $27 | 93% |
| Correct Care Solutions | $36 - $41 | 124% |
| Blue Cross Blue Shield | $38 | 131% |
| First Health | $39 - $280 | 134% |
| Multiplan | $40 - $547 | 138% |
| Health Partners Of Kansas | $105 - $304 | 361% |
| Wppa | $106 | 365% |
| Preferred Health Choices | $115 | 396% |
| Medical Associates Health Plan | $115 | 396% |
| Spirit Aerosystems | $195 | 671% |
| Triwest Healthcare Alliance | $395 | 1359% |
| Usa Managed Care | $517 | 1779% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Wesley Medical Center in Wichita, KS, the cash price is $608.00, which matches the facility's cash median. While the facility's negotiated rates with insurance payers range from $24 to $517, the cash price is notably higher than the median negotiated rate of $37.00 reported for this service. Patients with high-deductible plans or those without insurance may find paying the cash price directly more advantageous, as it avoids the administrative costs and potential out-of-pocket maximums associated with insurance claims. It is important to note that while the cash price exceeds the negotiated average, it remains significantly lower than the facility's gross chargemaster rate, which serves as the baseline for billing before any discounts are applied.
When evaluating the cost of this service, it is essential to compare the cash price against the Medicare benchmark rather than the hospital's full list price. The Medicare amount for this code is $29.06, and the cash price of $608.00 represents a markup of 1.3 times the Medicare rate. This comparison highlights that commercial rates often include additional layers of administrative overhead and risk that are not reflected in the federal baseline. To minimize costs, patients should 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. Additionally, if you have insurance, verify your specific plan's allowed amount before scheduling, as some in-network contracts may result in higher out-of-pocket costs than the cash option.