Physical therapy (gait training)
Facility: Menorah Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $40
- Cash Discount Price: $230
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $24 - $104 | 83% |
| Amerigroup | $24 | 83% |
| Coventry | $24 - $93 | 83% |
| United | $24 - $104 | 83% |
| Humana | $24 - $61 | 83% |
| Devoted Health | $24 - $28 | 83% |
| Wellcare | $25 - $28 | 86% |
| Unicare | $25 | 86% |
| Cigna | $25 - $184 | 86% |
| Healthyblue | $25 | 86% |
| Aetna | $25 - $117 | 86% |
| Celtic | $25 - $28 | 86% |
| Medicaid / KanCare | $25 | 86% |
| Pyramid Life | $26 - $30 | 89% |
| Home State Health Plan | $27 | 93% |
| Triwest Health Alliance | $27 | 93% |
| Multiplan | $33 - $170 | 114% |
| Corvel Corporation | $39 - $150 | 134% |
| Oha Network | $40 - $115 | 138% |
| Ambetter / Centene | $43 | 148% |
| Nhc Advantage | $44 | 151% |
| Oscar | $44 | 151% |
| Wppa Providrs Care Network | $46 | 158% |
| Universal Healthcare | $81 | 279% |
| Coventry Kc Mo | $94 | 323% |
| College Park Family Care Center | $99 | 341% |
| Focus Healthcare Mgmt, Inc | $173 | 595% |
| Cco, Inc. | $173 | 595% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, physical therapy (gait training), Menorah Medical Center in Overland Park, KS, lists a cash price of $230.00. This cash rate is significantly higher than the state average for this service, which is $29.06, representing a markup of 140% above the Medicare benchmark. While the facility offers a median negotiated rate of $40.00 for in-network patients, this amount is still nearly double the Medicare rate. For patients with high-deductible plans, paying the cash price of $230.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates from major payers like Cigna and Multiplan can reach as high as $170.00, which exceeds the cash price.
Patients should verify their specific plan details before scheduling, as some commercial payers may have negotiated rates that exceed the cash price due to administrative overhead and contract dynamics. It is advisable to 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 within a short window. Additionally, if you receive a bill from an out-of-network provider or encounter unexpected charges, you have the right to dispute balance billing under the No Surprises Act for non-emergency services. Always request a full, itemized CPT-coded bill before agreeing to any payment terms to ensure no unbundled codes or services not rendered are included in the final invoice.