Physical therapy (gait training)
Facility: Wayne General Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $60
- Cash Discount Price: $85
- vs. Medicare Baseline: 2.06x 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 206% of the Medicare baseline (a markup of 106%). 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 |
|---|---|---|
| Humana | $24 | 83% |
| Al Healthcare Adv Mcaid-All Plans | $25 | 86% |
| Alabama Community Mcaid-All Plans | $25 | 86% |
| Medicaid / KanCare | $25 | 86% |
| Univita Healthcare Mcaid-All Plans | $25 | 86% |
| Amerigroup Mcare Adv-All Plans | $27 | 93% |
| Cigna | $27 - $60 | 93% |
| Magnolia Mcare Adv | $27 | 93% |
| Molina Mcare Adv | $27 | 93% |
| Vantage Health Mcare Adv | $27 | 93% |
| Wellcare Mcare Adv-All Plans | $27 | 93% |
| Molina Chip-All Other Plans | $28 | 96% |
| Ml Healthcare-All Plans | $34 | 117% |
| Ahs-All Plans | $60 | 206% |
| Vantage Health-All Other Plans | $62 | 213% |
| Phcs-All Plans | $64 | 220% |
| Mhci/Healthlink Op Only-All Plans | $72 | 248% |
| Ms Health Partners-All Plans | $72 | 248% |
| Ppoplus-All Plans | $72 | 248% |
| First Choice-All Other Plans | $76 | 262% |
| First Health-All Plans | $76 | 262% |
| Geha Ppo-All Plans | $76 | 262% |
| Healthcare Advantage-All Plans | $76 | 262% |
| United Providers-All Plans | $76 | 262% |
| Three Rivers Provider Network-All Plans | $81 | 279% |
| Aetna | $85 | 292% |
| Magnolia Comm/Exchange-All Other Plans | $85 | 292% |
| First Choice Hie | $106 | 365% |
| Blue Cross Blue Shield | $159 | 547% |