Physical therapy (gait training)
Facility: Overland Park Reg Med Ctr
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $40
- Cash Discount Price: $446
- vs. Medicare Baseline: 1.38x 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 - $61 | 83% |
| United | $24 - $201 | 83% |
| Blue Cross Blue Shield | $24 - $192 | 83% |
| Coventry | $24 - $179 | 83% |
| Devoted Health | $24 - $28 | 83% |
| Amerigroup | $24 | 83% |
| Aetna | $25 - $228 | 86% |
| Healthyblue | $25 | 86% |
| Celtic | $25 - $28 | 86% |
| Wellcare | $25 - $28 | 86% |
| Unicare | $25 | 86% |
| Medicaid / KanCare | $25 | 86% |
| Cigna | $25 - $28 | 86% |
| Pyramid Life | $26 - $30 | 89% |
| Triwest Health Alliance | $27 | 93% |
| Home State Health Plan | $27 | 93% |
| Multiplan | $33 - $330 | 114% |
| Corvel Corporation | $39 - $290 | 134% |
| Oha Network | $40 - $223 | 138% |
| Ambetter / Centene | $83 | 286% |
| Nhc Advantage | $85 | 292% |
| Oscar | $85 | 292% |
| Wppa Providrs Care Network | $89 | 306% |
| Universal Healthcare | $156 | 537% |
| Coventry Kc Mo | $183 | 630% |
| College Park Family Care Center | $192 | 661% |
| Cco, Inc. | $335 | 1153% |
| Focus Healthcare Mgmt, Inc | $335 | 1153% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, the Overland Park Reg Med Ctr lists a cash price of $446.00. This cash rate is significantly higher than the national average for this service, which is $29.06 according to Medicare benchmarks. While the facility offers a negotiated rate of $40.00 for in-network patients, this amount is still above the Medicare baseline, suggesting that the commercial pricing structure includes substantial administrative markups. Patients with high-deductible plans or those who have not yet met their out-of-pocket maximum may find the cash price more favorable than the insurance negotiated rate, as paying the full $446.00 upfront could result in immediate coverage without waiting for deductible thresholds to be met.
It is important to note that the data reflects a wide range of negotiated rates across different payers, with some plans paying as low as $24 and others up to $335, indicating significant variation in contract terms. Because the facility is an acute care hospital in Kansas, patients should verify their specific plan's allowed amount before scheduling to avoid balance billing if they are out-of-network. If you are paying out-of-pocket, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final cost by 20% to 50% if settled within a short window. Additionally, if you receive a bill from this facility, request a detailed itemized statement to ensure no unbundled codes or services not rendered have inflated your total, as summary bills often obscure these errors.