Physical therapy (gait training)
Facility: St Francis Hospital - the Heart Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $85
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.92x 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 292% of the Medicare baseline (a markup of 192%). 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 |
|---|---|---|
| Affinity Health Plan | $29 - $65 | 100% |
| Centerlight Healthcare | $29 | 100% |
| Elderplan Inc. | $29 | 100% |
| Emblem Health | $29 - $80 | 100% |
| Fidelis Care New York | $29 - $65 | 100% |
| Health First | $29 - $65 | 100% |
| Health Plus | $29 - $65 | 100% |
| Independent Health | $29 | 100% |
| Medicaid / KanCare | $29 | 100% |
| Mvp Health Plans | $29 - $293 | 100% |
| Senior Whole Health | $29 | 100% |
| UnitedHealthcare | $29 - $303 | 100% |
| Us Family Health Plan | $41 | 141% |
| Zadroga | $49 | 169% |
| Centers Plan For Healthy Living | $53 | 182% |
| Liberty Health | $71 | 244% |
| Oscar Health | $73 | 251% |
| American Plan Administrators | $80 | 275% |
| Amerihealth Administrators | $80 | 275% |
| Benefit Services | $80 | 275% |
| Blue Cross Blue Shield | $80 - $106 | 275% |
| Ghi Cbp Ny City Employee Alternate | $80 | 275% |
| International Benefit Administrator | $80 | 275% |
| Ultra Benefits Inc. | $80 | 275% |
| Aetna | $89 - $356 | 306% |
| Self Pay | $106 | 365% |
| Allied Wellfare Fund | $125 | 430% |
| American Group Administrators | $125 | 430% |
| Bakery & Confectionery Union | $125 | 430% |
| Cigna | $125 - $293 | 430% |
| Comprehensive Benefits Consultant | $125 | 430% |
| Guardian Life Insurance Company Of America | $125 | 430% |
| Maloney And Assoc | $125 | 430% |
| Multiplan | $125 | 430% |
| Performax | $125 | 430% |
| Phcs | $125 | 430% |
| Pomco | $125 | 430% |
| Tpa Inc | $125 | 430% |
| Unicare | $125 | 430% |
| United Employees Health Plan | $125 | 430% |
| Coventry | $132 - $148 | 454% |
| Longevity Health Plan | $142 | 489% |
| Galaxy | $160 | 551% |
| Three Rivers Provider Network | $160 | 551% |
| Aither Health | $178 | 613% |
| Alpha Care | $178 | 613% |
| Dentaquest | $178 | 613% |
| Veterans Affairs | $178 | 613% |
| Local 1199 | $200 | 688% |
| Brighton | $266 - $356 | 915% |
| Centivo | $272 - $293 | 936% |
| Apwu | $293 | 1008% |
| Daniel H Cook | $293 | 1008% |
| Nalc | $293 | 1008% |
| Samba | $293 | 1008% |
| Surest | $303 | 1043% |
| Mail Handlers Benefit Plan | $356 | 1225% |
| Meritain Health | $356 | 1225% |
| Nippon Life Insurance Company Of America | $356 | 1225% |
| Salvation Army | $356 | 1225% |