Physical therapy (gait training)
Facility: Kansas City Orthopaedic Institute
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $92
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.17x 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 317% of the Medicare baseline (a markup of 217%). 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 |
|---|---|---|
| UnitedHealthcare | $37 - $124 | 127% |
| Aetna | $37 | 127% |
| Cigna | $37 - $125 | 127% |
| Blue Cross Blue Shield | $67 - $107 | 231% |
| Medica | $172 | 592% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, Physical therapy (gait training), the Kansas City Orthopaedic Institute in Leawood, KS, has a gross charge of $140.00. This facility is a Physician-owned Acute Care Hospital located in zip code 66211. When comparing pricing, the facility's negotiated rates with major payers like UnitedHealthcare, Cigna, and Blue Cross Blue Shield range from $37 to $125, while Medica has a fixed negotiated rate of $172. It is important to note that cash-pay rates are not available for this specific service at this facility. Patients should be aware that while commercial negotiated rates can sometimes exceed cash prices, this option is not applicable here. Additionally, the facility's pricing structure should be evaluated against state and county averages to ensure transparency, though specific comparative averages for this code were not provided in the current dataset.
The Medicare amount for this service is $29.06, which serves as a critical benchmark for understanding the facility's pricing markup. The facility's median negotiated rate is $92.00, which is significantly higher than the Medicare rate of $29.06. This disparity highlights the difference between the federal government's cost-based reimbursement and the commercial rates charged to insured patients. For patients with high-deductible plans, it is worth noting that if the insurance negotiated rate exceeds the cash price, paying out-of-pocket might be more cost-effective, although this facility does not offer a cash price. To avoid unexpected costs, patients should verify their deductible status before scheduling and request a full itemized bill to identify any potential errors, unbundled codes,