Physical therapy (gait training)
Facility: Medstar Harbor Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $155
- Cash Discount Price: $152
- vs. Medicare Baseline: 5.33x 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 533% of the Medicare baseline (a markup of 433%). 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 |
|---|---|---|
| Aetna | $155 | 533% |
| Amerigroup | $155 | 533% |
| Amerihealth Caritas District Of Columbia | $155 | 533% |
| Carefirst Advantage Inc | $155 | 533% |
| Carefirst Blue Choice Inc | $155 | 533% |
| Cigna | $155 | 533% |
| First Health | $155 | 533% |
| Hscsn | $155 | 533% |
| Humana | $155 | 533% |
| Kaiser Permanente | $155 | 533% |
| Magellan Behavioral Health Inc | $155 | 533% |
| Mamsi | $155 | 533% |
| Medstar Family Choice | $155 | 533% |
| Medstar Family Choice Inc | $155 | 533% |
| Ncppo Healthlink Ppo | $155 | 533% |
| Pfc | $155 | 533% |
| Private Healthcare Systems (Phcs) | $155 | 533% |
| Tricare | $155 | 533% |
| United Behavioral Health Inc | $155 | 533% |
| UnitedHealthcare | $155 | 533% |
Consumer Guidance & Cost Commentary
For patients paying out-of-pocket, the cash median rate for this physical therapy procedure (gait training) is $152.00, which is notably lower than the facility's gross charge of $155.00. While the cash price is modest, it is important to note that commercial insurance contracts often result in higher out-of-pocket costs for members, particularly if their deductible has not yet been met. In this specific case, every listed payer, including major networks like UnitedHealthcare and Cigna, has a high and low negotiated rate of $155.00. This means that for many insured patients, paying cash upfront could potentially save money compared to the standard negotiated rate, provided the insurance plan does not cover the full amount or has a high deductible.
When viewed against the broader healthcare landscape, this service is priced significantly above the Medicare benchmark. The Medicare amount for this procedure is $29.06, while the facility's cash rate is $152.00, a disparity highlighted by a 5.3x multiplier compared to the federal baseline. Although the facility is a Voluntary non-profit - Private hospital with a strong 4-star rating in Baltimore, MD, the pricing structure reflects standard commercial negotiations where rates often range between 200% and 300% of the Medicare cost. Patients are encouraged to verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can further reduce the final bill by bypassing the administrative overhead associated with insurance claims processing.