Physical therapy (gait training)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $57
- Cash Discount Price: $67
- vs. Medicare Baseline: 1.96x 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 |
|---|---|---|
| First Health Contracted [320128] | $21 | 72% |
| Aetna | $21 - $27 | 72% |
| Blue Cross Blue Shield | $24 - $33 | 83% |
| Medicaid / KanCare | $24 - $27 | 83% |
| UnitedHealthcare | $25 - $104 | 86% |
| Humana | $26 - $27 | 89% |
| Cherokee Nation Health Serv Contracted [320066] | $27 | 93% |
| Centivo Contracted [320505] | $27 | 93% |
| Cross Timbers Hospice [20098] | $27 | 93% |
| Kindful Hospice Contracted [320434] | $27 | 93% |
| Elara Caring Aspire Hospice [20433] | $27 | 93% |
| Medicare (plans) | $27 | 93% |
| Mercy Hospice Okc [20252] | $27 | 93% |
| Mercy Mgd Behavioral Health Contracted [320259] | $27 | 93% |
| Dept Of Veteran Affairs Contracted [320106] | $27 | 93% |
| Cigna | $27 - $79 | 93% |
| Tricare | $27 | 93% |
| Medical Associates Health Contracted [320444] | $27 | 93% |
| Globalhealth Contracted [320145] | $27 | 93% |
| Qual Choice Contracted [320325] | $27 | 93% |
| Halo Hcr Inc Hospice [20432] | $27 | 93% |
| Kindful Hospice [20434] | $27 | 93% |
| Halo Hcr Inc Hospice Contracted [320432] | $27 | 93% |
| Pace Of The Ozarks Contracted [320518] | $27 | 93% |
| Provider Partners Health Plans Contracted [320450] | $29 | 100% |
| Medica Contracted [320239] | $37 | 127% |
| Providrs Care Network Contracted [320484] | $52 | 179% |
| Point C Contracted [320238] | $52 - $77 | 179% |
| Show-Me Health Administrators Contracted [320483] | $62 | 213% |
| Mercy Benefit Admin Contracted [320251] | $62 - $72 | 213% |
| Aither Health Contracted [320449] | $72 | 248% |
| Ebms Contracted [320493] | $72 | 248% |
| Reflect Health Contracted [320492] | $72 | 248% |
| Auxiant Contracted [320462] | $72 - $77 | 248% |
| Imagine 360 Contracted [320494] | $72 | 248% |
| Yuzu Health Contracted [320521] | $72 | 248% |
| American Healthcare Alliance Contracted [320020] | $72 | 248% |
| Edison Health Solutions Contracted [320502] | $72 | 248% |
| Federal Medical Center Contracted [320127] | $77 | 265% |
| Health Systems Inc Contracted [320174] | $77 | 265% |
| United Medical Resources Contracted [320454] | $77 - $102 | 265% |
| Insurance System Inc Contracted [320465] | $77 | 265% |
| Healthscope Contracted [320182] | $77 | 265% |
| Preferred Health Plan Contracted [320522] | $77 | 265% |
| Healthlink Contracted [320179] | $77 | 265% |
| Benefit Management Contracted [320052] | $77 | 265% |
| Compcare Of The Ozarks Contracted [320437] | $81 | 279% |
| Workers Comp [20426] | $82 | 282% |
| Private Health Care Systems Contracted [320320] | $95 | 327% |
| Multiplan [20270] | $98 | 337% |
| Multiplan Contracted [320270] | $98 | 337% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, Physical therapy (gait training), the facility's cash median rate is $67.00, which is lower than the negotiated rates paid by most insurance plans. While the gross charge is $103.00, patients with high-deductible plans might find paying the cash price directly more affordable than facing a negotiated rate that could exceed their out-of-pocket maximum. It is important to note that many commercial payers, such as UnitedHealthcare and Point C, have negotiated ranges starting as high as $52.00 and reaching up to $104.00, meaning the cash price offers a potential savings for those who do not have insurance or have already met their deductible. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final cost by bypassing the administrative overhead associated with insurance billing cycles.
When evaluating the fairness of these rates, it is helpful to compare them against the Medicare benchmark, which serves as a scientifically validated baseline for the true cost of care. For this specific procedure, the Medicare amount is $29.06, and the facility's cash rate of $67.00 represents a markup of approximately 2.0 times the Medicare rate. While commercial negotiated rates often average between 200% and 300% of Medicare, the cash price here remains significantly lower than the majority of in-network allowed amounts. Consumers should be aware of balance billing risks if they receive care from out-of-network providers, where the provider could bill the difference between the full chargemaster and the insurance allowed amount,