Physical therapy (gait training)
Facility: Kansas Surgery & Recovery Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $43
- Cash Discount Price: $63
- vs. Medicare Baseline: 1.48x 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 |
|---|---|---|
| UnitedHealthcare | $27 - $68 | 93% |
| Blue Cross Blue Shield | $27 - $33 | 93% |
| Aetna | $27 - $43 | 93% |
| Cigna | $59 - $68 | 203% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Kansas Surgery & Recovery Center in Wichita, KS, the cash median price is $63.00, which is nearly identical to the facility's gross charge of $64.00. While the facility is an Acute Care Hospital owned by a voluntary non-profit, the negotiated rates for in-network payers like UnitedHealthcare, Blue Cross Blue Shield, Aetna, and Cigna range from $27 to $68, often exceeding the cash price. This pricing structure highlights a common scenario where paying out-of-pocket can be more cost-effective than using insurance, as commercial negotiated rates frequently include administrative overhead that inflates the final bill. Patients with high-deductible plans should consider paying the cash median of $63.00 directly, provided they verify that their specific plan does not cover this service or if the deductible has not been met.
To ensure you are not overcharged, it is critical to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, you should still review your statement line-by-line to confirm no duplicate charges exist. Additionally, ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid in full upfront. Since the facility is located in Wichita (ZIP 67226), these rates reflect local market dynamics, and comparing the $63.00