Physical therapy (gait training)
Facility: Ascension Via Christi Rehabilitation Hospital Inc
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $28
- Cash Discount Price: Unavailable
- 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% |
| Medicare (plans) | $27 - $28 | 93% |
| Va | $27 | 93% |
| Vc Hope | $27 | 93% |
| Blue Cross Blue Shield | $28 | 96% |
| UnitedHealthcare | $28 - $77 | 96% |
| Smarthealth | $38 | 131% |
| Medicaid / KanCare | $46 | 158% |
| Aetna | $62 - $92 | 213% |
| Coventry City Of Wichita | $64 | 220% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Ascension Via Christi Rehabilitation Hospital Inc in Wichita, KS, the facility's negotiated rates range from $27 to $92 depending on the payer. The lowest negotiated amount is $27, which aligns with the rates for Humana, Medicare, and VA, while the highest is $92 for Aetna. When compared to the Medicare benchmark of $29.06, the facility's median negotiated rate of $28.00 is slightly lower, indicating a relative value of 1.0. This suggests that for patients with commercial insurance, the facility's contracted rates are competitive with federal standards, though the wide variance among payers highlights the importance of verifying specific plan allowances before scheduling.
Patients should be aware that while in-network status protects against balance billing, it does not guarantee the lowest possible price, as commercial negotiated rates often exceed cash prices due to administrative overhead. For individuals with high-deductible plans, paying the cash price or a prompt-pay discount upfront could result in lower out-of-pocket costs than the insurance negotiated rate, provided the deductible has not been met. We recommend contacting the hospital directly to inquire about self-pay or prompt-pay discounts, which can offer immediate fee reductions by bypassing the standard insurance billing cycle. Additionally, since over 80% of hospital bills contain errors, patients should request a full itemized statement to review every charge and dispute any inaccuracies before finalizing payment.