Physical therapy (gait training)
Facility: Children'S Mercy South
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $64
- Cash Discount Price: $59
- vs. Medicare Baseline: 2.20x 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 220% of the Medicare baseline (a markup of 120%). 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 |
|---|---|---|
| Cigna | $12 - $93 | 41% |
| UnitedHealthcare | $23 - $90 | 79% |
| Healthy Blue | $24 - $77 | 83% |
| Medicaid / KanCare | $25 - $28 | 86% |
| Home State Health | $31 - $68 | 107% |
| Wppa Providrs Care | $34 - $87 | 117% |
| Quiktrip | $34 - $87 | 117% |
| Blue Cross Blue Shield | $34 - $99 | 117% |
| Healthlink | $37 - $118 | 127% |
| Health Midwest Comprehensive Care | $39 - $87 | 134% |
| American Healthcare Alliance | $41 - $114 | 141% |
| Multiplan | $43 - $102 | 148% |
| Aetna | $43 - $91 | 148% |
| Humana | $51 - $89 | 175% |
| Orscheln | $52 - $87 | 179% |
| Wellfit/Centrus | $54 - $87 | 186% |
| Coventry Health Care Of Kansas | $54 - $99 | 186% |
| Centivo | $56 - $87 | 193% |
| Nebraska Furniture Mart | $56 - $87 | 193% |
| Medica | $64 - $78 | 220% |
| Mercy Health | $80 - $100 | 275% |
| Coxhealth Network | $81 - $99 | 279% |
| National Preferred Provider Network | $97 - $121 | 334% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Children's Mercy South in Overland Park, KS, lists a cash median price of $59.00. This cash rate is significantly lower than the facility's negotiated rates with major payers, which range from $12 to $121 depending on the insurance plan. While the facility's negotiated rates generally exceed the Medicare benchmark of $29.06, patients with high-deductible plans may find the cash price more affordable if their insurance negotiated rate is higher than $59.00. It is important to note that commercial rates often include administrative overhead and contract dynamics that can inflate the baseline price compared to the federal government's cost-based Medicare calculation.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, unexpected charges can still occur for ancillary services or if a specific provider is out-of-network. To avoid surprise bills, consumers should request a full itemized bill before paying and verify that all services rendered are accurately coded. Additionally, patients should proactively ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final amount owed by offering immediate payment. Since over 80% of hospital bills contain errors, disputing any discrepancies in writing with a certified copy is the most effective way to ensure the final invoice reflects only the services actually provided.