CMS Price Transparency Data

Physical therapy (gait training)

Facility: The Children's Mercy Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $64
Cash Discount Price: $59
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at The Children's Mercy Hospital is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.20x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $59 (203%)

Insurance Median: $64 (220%)

Cash: $59 (203% of Medicare)

Ins. Median: $64 (220% of 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.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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%
Blue Cross Blue Shield	$34 - $99	117%
Quiktrip	$34 - $87	117%
Wppa Providrs Care	$34 - $87	117%
Healthlink	$37 - $118	127%
Health Midwest Comprehensive Care	$39 - $87	134%
American Healthcare Alliance	$41 - $114	141%
Aetna	$43 - $91	148%
Multiplan	$43 - $102	148%
Humana	$51 - $89	175%
Orscheln	$52 - $87	179%
Coventry Health Care Of Kansas	$54 - $99	186%
Wellfit/Centrus	$54 - $87	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%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $59.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97116.

Insurance In-Network Protection Plan

Contact your insurance company to confirm The Children's Mercy Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97116.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.