Physical therapy (gait training)
Facility: Saint Luke'S South Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $85
- Cash Discount Price: $193
- vs. Medicare Baseline: 2.92x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 292% of the Medicare baseline (a markup of 192%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $18 - $306 | 62% |
| Medicaid / KanCare | $24 - $38 | 83% |
| Transplants-Case Rates [5750] | $25 - $322 | 86% |
| Blue Cross Blue Shield | $31 - $76 | 107% |
| UnitedHealthcare | $42 - $127 | 145% |
| Humana | $51 - $103 | 175% |
| Cigna | $88 - $289 | 303% |
| First Health [5512] | $191 | 657% |
| Commercial-Contracted [8000] | $203 - $260 | 699% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Saint Luke's South Hospital in Overland Park, KS, the cash price is $193.00, which is notably lower than the facility's negotiated rates with major payers like Aetna ($18–$306) and Medicaid/KanCare ($24–$38). While the median amount paid by insurers is $271.00, patients with high-deductible plans may find the cash price more affordable if their insurance negotiated rate exceeds $193.00. It is important to note that commercial negotiated rates often include administrative overhead and can be significantly higher than the cash price, so patients should verify their specific plan's allowed amount before scheduling to ensure they are not paying more than necessary.
The facility's cash rate of $193.00 is also lower than the state average for this service, though the data does not provide a specific county average for Kansas to make a direct comparison. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services are billed separately. To avoid surprise costs, consumers should request a full itemized bill before paying and dispute any errors in writing, as over 80% of hospital bills contain mistakes. Additionally, asking the hospital about self-pay or prompt-pay discounts upfront can help secure the lowest possible rate, as these discounts bypass the costly insurance claims process.