Physical therapy (gait training)
Facility: Kansas Medical Center Llc
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $28
- Cash Discount Price: $40
- 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 |
|---|---|---|
| Medicaid / KanCare | $24 | 83% |
| Indian Health | $25 | 86% |
| Tricare | $25 | 86% |
| Wppa | $27 | 93% |
| Humana | $28 | 96% |
| Ambetter / Centene | $28 | 96% |
| Medadv_Wellcare | $28 | 96% |
| Blue Cross Blue Shield | $28 - $44 | 96% |
| Aetna | $55 | 189% |
| Three_Rivers | $55 | 189% |
| United | $67 | 231% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Kansas Medical Center Llc in Andover, the cash price of $40.00 is lower than the state average of $55.00, making it a cost-effective option for those without insurance. While most commercial payers negotiate rates ranging from $24 to $55, the cash rate remains the lowest fixed price available. Patients with high-deductible plans or those who have already met their out-of-pocket maximum may find paying the $40.00 cash price more beneficial than relying on insurance, as the negotiated rates for many plans exceed the cash amount. To secure the best possible price, it is recommended to explicitly ask the facility about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the total cost.
The facility's billing practices align with federal protections under the No Surprises Act, which prevents balance billing for out-of-network services at in-network hospitals, though patients should still review their itemized bills for any unbundled codes or services not rendered. Since over 80% of hospital bills contain errors, consumers should request a detailed, line-by-line statement rather than accepting a summary invoice that obscures individual charges. By comparing the facility's rates directly to the Medicare benchmark of $29.06, it becomes clear that the cash price of $40.00 represents a reasonable market rate, while commercial negotiated rates reflect the administrative costs and contract dynamics inherent in the insurance system.