Physical therapy (gait training)
Facility: Ann & Robert H Lurie Childrens Hospital of Chicago
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $134
- Cash Discount Price: $117
- vs. Medicare Baseline: 4.61x 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 461% of the Medicare baseline (a markup of 361%). 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 |
|---|---|---|
| Medicare (plans) | $28 - $2,656 | 96% |
| Mercycare Health | $62 | 213% |
| Cigna | $70 - $119 | 241% |
| Blue Cross Blue Shield | $72 - $134 | 248% |
| Beacon Health Options | $84 | 289% |
| Aetna | $84 - $131 | 289% |
| La Rabida Childrens Hospital | $84 | 289% |
| UnitedHealthcare | $96 - $118 | 330% |
| Centegra | $100 | 344% |
| Independent Physicians at Mercy | $100 | 344% |
| St. Francis | $117 | 403% |
| Health Plus | $117 | 403% |
| Methodist First Choice | $117 | 403% |
| Imagine Health | $117 | 403% |
| Ui Health | $117 | 403% |
| Advanced Physicians Association IPA | $117 | 403% |
| West Suburban Health Providers | $117 | 403% |
| Presence Health Partners | $117 | 403% |
| Northwest Community Healthcare | $117 | 403% |
| Swedish Covenant Physician Partners | $125 | 430% |
| Shriners Hospital | $125 | 430% |
| Health Alliance | $134 | 461% |
| Magellan | $134 - $900 | 461% |
| American Psych Systems | $134 | 461% |
| Macneal Health | $134 | 461% |
| Healthlink Inc. | $138 | 475% |
| Principal Healthcare | $142 | 489% |
| Hfn Inc | $142 - $150 | 489% |
| Humana | $142 | 489% |
| Cofinity | $142 | 489% |
| St. Elizabeth | $142 | 489% |
| First Health | $147 | 506% |
| Sagamore Health Network | $147 | 506% |
| Preferred Health Network | $147 | 506% |
| Healthstar | $147 | 506% |
| Benchmark Health | $150 | 516% |
| Private Health Care System | $150 | 516% |
| Employer's Coalition on Health | $150 | 516% |
| Security Health Plan | $150 | 516% |
| Swedish American | $150 | 516% |
| Beech Street | $150 | 516% |
| Wellmark/Healthnetwork | $154 | 530% |
| Health Smart | $159 | 547% |
| Wea Insurance Group | $159 | 547% |
| Integrated Health Plan | $159 | 547% |
| Multiplan | $159 | 547% |
| National Provider Network | $159 | 547% |
| Unicare | $3,678 - $8,500 | 12657% |