Physical therapy (gait training)
Facility: Kosciusko Community Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $69
- Cash Discount Price: $40
- vs. Medicare Baseline: 2.37x 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 237% of the Medicare baseline (a markup of 137%). 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 |
|---|---|---|
| Amish Aid | $15 - $46 | 52% |
| Self Pay | $15 - $85 | 52% |
| Theramatrix | $22 | 76% |
| Lutheran Preferred Network | $23 - $174 | 79% |
| UnitedHealthcare | $25 - $186 | 86% |
| Tricare | $26 | 89% |
| Aetna | $27 - $115 | 93% |
| Blue Cross Blue Shield | $27 - $186 | 93% |
| Humana | $27 - $186 | 93% |
| Medicare (plans) | $27 | 93% |
| Mhs | $27 - $186 | 93% |
| Physicians Health Plan | $27 - $100 | 93% |
| Department Of Veterans Affairs | $28 | 96% |
| Iu Health | $28 | 96% |
| Node Devoted Health Mcr Adv | $28 | 96% |
| Node Non Par Hospice Agree | $28 | 96% |
| Node Va | $28 | 96% |
| One Call Care Diagnostics Wc | $28 | 96% |
| Php Freedom Network | $28 - $84 | 96% |
| Veterans Eval Services | $28 | 96% |
| Encore | $29 - $87 | 100% |
| In Dept Of Correction | $29 | 100% |
| Node Pphp Mcr Adv | $29 | 100% |
| Trma Inc | $29 - $98 | 100% |
| Lutheran Advanced Network | $42 | 145% |
| Lutheran Preferred | $42 - $56 | 145% |
| Connecticut General Life Insurance Company | $43 - $128 | 148% |
| Us Department Of Labor | $43 | 148% |
| Align In Work Comp | $45 | 155% |
| One Call Work Comp | $45 | 155% |
| Cigna | $46 - $137 | 158% |
| Encore Work Comp In | $50 | 172% |
| Prime Health Services | $50 - $163 | 172% |
| First Health Network | $55 - $163 | 189% |
| Managed Health Services Exchange | $56 | 193% |
| Workers Comp | $56 | 193% |
| Advantage Health | $61 - $180 | 210% |
| Private Healthcare Systems | $63 - $187 | 217% |
| Sagamore | $64 - $204 | 220% |
| Encore Kba Epo | $67 | 231% |
| Encore Health Network | $68 - $202 | 234% |
| Encore Kba Ppo | $84 | 289% |
| Caresource | $143 - $186 | 492% |
| Managed Health Services | $186 | 640% |
| Medicaid / KanCare | $186 | 640% |