Physical therapy (gait training)
Facility: Mercy Hospital Aurora
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $99
- Cash Discount Price: $76
- vs. Medicare Baseline: 3.41x 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 341% of the Medicare baseline (a markup of 241%). 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 |
|---|---|---|
| Medicaid / KanCare | $24 - $59 | 83% |
| Medicare (plans) | $28 - $35 | 96% |
| Aetna | $33 - $104 | 114% |
| Blue Cross Blue Shield | $33 - $117 | 114% |
| Cherokee Nation Health Serv Contracted [320066] | $33 | 114% |
| Cigna | $33 - $99 | 114% |
| Cross Timbers Hospice [20098] | $33 | 114% |
| Elara Caring Aspire Hospice [20433] | $33 | 114% |
| Globalhealth Contracted [320145] | $33 | 114% |
| Halo Hcr Inc Hospice Contracted [320432] | $33 | 114% |
| Halo Hcr Inc Hospice [20432] | $33 | 114% |
| Humana | $33 - $99 | 114% |
| Indian Health Service Contracted [320198] | $33 | 114% |
| Kindful Hospice Contracted [320434] | $33 | 114% |
| Kindful Hospice [20434] | $33 | 114% |
| Medical Associates Health Contracted [320444] | $33 | 114% |
| Mercy Hospice Okc [20252] | $33 | 114% |
| Mercy Mgd Behavioral Health Contracted [320259] | $33 | 114% |
| Pace Of The Ozarks Contracted [320518] | $33 | 114% |
| Provider Partners Health Plans Contracted [320450] | $33 | 114% |
| Qual Choice Contracted [320325] | $33 | 114% |
| UnitedHealthcare | $33 - $111 | 114% |
| Dept Of Veteran Affairs Contracted [320106] | $34 | 117% |
| Tricare | $34 | 117% |
| Healthscope Contracted [320182] | $43 | 148% |
| Centivo Contracted [320505] | $47 | 162% |
| Administrative Payor Contracted [320005] | $53 | 182% |
| Ambetter / Centene | $59 | 203% |
| Home State Health Plan Contracted [320187] | $59 | 203% |
| Novasys Contracted [320285] | $59 | 203% |
| Healthlink Contracted [320179] | $76 - $105 | 262% |
| Preferred Health Plan Contracted [320522] | $76 | 262% |
| Health Systems Inc Contracted [320174] | $94 | 323% |
| Insurance System Inc Contracted [320465] | $94 | 323% |
| Point C Contracted [320238] | $94 - $99 | 323% |
| Point C [20238] | $94 | 323% |
| Workers Comp [20426] | $94 - $99 | 323% |
| 90 Degree Benefits Contracted [320436] | $99 | 341% |
| Aither Health Contracted [320449] | $99 | 341% |
| American Healthcare Alliance Contracted [320020] | $99 | 341% |
| Auxiant Contracted [320462] | $99 | 341% |
| Benefit Management Contracted [320052] | $99 | 341% |
| Ebms Contracted [320493] | $99 | 341% |
| Edison Health Solutions Contracted [320502] | $99 | 341% |
| Evolutions Health Care Contracted [320124] | $99 | 341% |
| First Health Contracted [320128] | $99 | 341% |
| Imagine 360 Contracted [320494] | $99 | 341% |
| Medica Contracted [320239] | $99 | 341% |
| Mercy Benefit Admin Contracted [320251] | $99 | 341% |
| Reflect Health Contracted [320492] | $99 | 341% |
| Show-Me Health Administrators Contracted [320483] | $99 | 341% |
| United Medical Resources Contracted [320454] | $99 - $103 | 341% |
| Yuzu Health Contracted [320521] | $99 | 341% |
| Usa Managed Care Org Contracted [320429] | $103 | 354% |
| Multiplan Contracted [320270] | $111 | 382% |
| Private Health Care Systems Contracted [320320] | $111 | 382% |