Physical therapy (gait training)
Facility: Providence Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $29
- Cash Discount Price: $27
- vs. Medicare Baseline: 1.00x 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 |
|---|---|---|
| Aetna | $23 - $42 | 79% |
| UnitedHealthcare | $24 - $137 | 83% |
| Medicaid / KanCare | $24 | 83% |
| Celtic | $25 - $44 | 86% |
| Healthy Blue | $25 - $29 | 86% |
| Midland Care Connection | $28 | 96% |
| Cigna | $28 | 96% |
| Medicare (plans) | $28 | 96% |
| Tricare | $28 | 96% |
| Blue Cross Blue Shield | $28 - $66 | 96% |
| Kansas Superior Select | $29 | 100% |
| Corizon | $36 | 124% |
| Employer Direct Healthcare | $39 | 134% |
| Well Path Prison | $39 | 134% |
| Centurion | $41 | 141% |
| Naphcare | $43 | 148% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Providence Medical Center in Kansas City, KS, the facility's cash median rate is $27.00, which is significantly lower than the state average of $560.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Blue Cross Blue Shield range from $23 to $66, these amounts often exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the cash rate directly, as the insurance negotiated rates can sometimes be higher than the self-pay amount. It is important to verify the specific "self-pay" or "prompt-pay" discount offered by the hospital before scheduling, as paying in full upfront can sometimes result in a fee reduction that further lowers the total cost compared to standard billing cycles.
The facility's billing practices align with federal protections under the No Surprises Act, which prohibits balance billing for out-of-network services at in-network facilities, though patients should still review their itemized bills to ensure no unbundled codes or services not rendered are included. Since over 80% of hospital bills contain errors, consumers are encouraged to request a detailed, line-by-line itemized audit rather than accepting a summary bill that obscures individual charges. When evaluating the cost, it is more accurate to compare the facility's rates against the Medicare benchmark of $29.06 rather than the gross chargemaster price of $385.00, as Medicare rates represent the true cost baseline. By comparing the facility's negotiated rates to this benchmark, patients can better understand the markup and determine if the commercial rates are reasonable relative to the