Physical therapy (gait training)
Facility: Kansas Spine & Specialty Hospital, Llc
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $28
- Cash Discount Price: $53
- vs. Medicare Baseline: 0.96x 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 | $27 | 93% |
| United Mine Workers Of America | $28 | 96% |
| Providrs Care Network | $28 | 96% |
| UnitedHealthcare | $28 - $33 | 96% |
| Aetna | $28 - $34 | 96% |
| Blue Cross Blue Shield | $28 | 96% |
| Lantern Specialty Care | $44 | 151% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, the Kansas Spine & Specialty Hospital, Llc in Wichita, KS, lists a gross charge of $82.00. While the facility's cash median rate is $53.00 and the median negotiated rate across payers is $28.00, these figures are significantly higher than the Medicare benchmark of $29.06. Under Medicare benchmarking principles, commercial rates often range from 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150%. In this instance, the gross charge represents a substantial markup compared to the federal baseline, illustrating why comparing against the chargemaster can be misleading; the true cost baseline for evaluation is the Medicare rate.
Patients should be aware that insurance negotiated rates, which average $28.00 to $34.00 depending on the carrier, may still exceed the cash price of $53.00 if the patient's deductible has not been met, as the negotiated rate includes administrative overhead and contract dynamics. To potentially lower costs, patients are encouraged to verify their specific plan's allowed amount before scheduling and to inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can offer fee reductions for upfront payment. Additionally, since over 80% of hospital bills contain errors, patients should request a detailed, itemized billing audit rather than accepting a summary bill, ensuring that no services were unbundled or incorrectly charged before finalizing payment.