Physical therapy (gait training)
Facility: Lmh
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $28
- Cash Discount Price: $50
- 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 | $24 - $129 | 83% |
| UnitedHealthcare | $24 - $185 | 83% |
| Allwell | $25 - $28 | 86% |
| Aetna | $27 - $166 | 93% |
| Haskell Indian Health Services | $28 | 96% |
| Cigna | $28 - $134 | 96% |
| Humana | $28 | 96% |
| Medicare (plans) | $28 | 96% |
| Ambetter / Centene | $36 - $43 | 124% |
| Non Contracted | $160 | 551% |
| First Health | $186 | 640% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, Physical therapy (gait training), Lmh in Lawrence, KS, has a gross charge of $200.00. The facility's cash median rate is $50.00, which is significantly lower than the state average for this service. While many commercial payers like Blue Cross Blue Shield and UnitedHealthcare have negotiated rates ranging from $24 to $185, these amounts often exceed the cash price. For patients with high-deductible plans, paying the cash rate of $50.00 upfront can be more cost-effective than relying on insurance, which may result in higher out-of-pocket costs if the negotiated allowed amount surpasses the cash price. Additionally, patients should inquire about prompt-pay discounts, which can further reduce the cash bill by paying in full within a short window, bypassing the administrative overhead associated with insurance claims.
The facility's Medicare benchmark rate is $29.06, serving as a baseline for evaluating pricing fairness. Commercial negotiated rates from in-network payers generally fall between 1.0 and 1.0 times the Medicare amount for this specific service, indicating that the facility is charging at or near the federal benchmark rather than applying a significant markup. However, the "Non Contracted" rate of $160.00 and the "First Health" rate of $186.00 represent out-of-network or non-negotiated scenarios where balance billing could occur if not carefully managed. Under the No Surprises Act, patients receiving care at this in-network facility are protected from balance billing by out-of-network providers for emergency or non-emergency services. To ensure transparency, patients