Physical therapy (gait training)
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $28
- Cash Discount Price: $30
- vs. Medicare Baseline: 0.96x 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.
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 | $23 - $25 | 79% |
| UnitedHealthcare | $24 - $77 | 83% |
| Aetna | $25 | 86% |
| Humana | $27 - $28 | 93% |
| Va | $27 | 93% |
| Medicare (plans) | $27 - $28 | 93% |
| Providrs Care | $36 | 124% |
| Smarthealth | $38 | 131% |
| Ambetter / Centene | $46 | 158% |
| Blue Cross Blue Shield | $50 - $53 | 172% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Ascension Via Christi Hospital Manhattan, Inc. lists a cash median price of $30.00, which is significantly lower than the facility's gross charge of $74.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Blue Cross Blue Shield range from $23 to $53, the cash price offers a potential savings opportunity for patients with high-deductible plans or those without insurance. It is important to note that commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics; therefore, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the higher costs associated with insurance billing cycles.
This service is benchmarked against Medicare, which sets a fixed reimbursement rate of $29.06 for this procedure. The facility's cash price of $30.00 is nearly identical to the Medicare amount, suggesting a fair pricing structure that aligns closely with the federal cost baseline rather than inflated chargemaster lists. For patients concerned about balance billing or unexpected out-of-network charges, it is advisable to request a full itemized bill before payment to verify that all services rendered are accurately coded and that no unbundled charges or duplicate fees are included. By comparing the facility's rates directly to the Medicare benchmark and seeking prompt-pay incentives, consumers can avoid common pitfalls such as paying full list prices or accepting summary bills that obscure individual costs.