Physical therapy (gait training)
Facility: St. Catherine Hospital - Garden City
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $113
- Cash Discount Price: $74
- vs. Medicare Baseline: 3.89x 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 389% of the Medicare baseline (a markup of 289%). 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 |
|---|---|---|
| UnitedHealthcare | $29 - $232 | 100% |
| Blue Cross Blue Shield | $30 - $205 | 103% |
| Aetna | $30 - $160 | 103% |
| Innovage | $30 | 103% |
| Kaiser | $30 - $79 | 103% |
| Humana | $30 | 103% |
| Medicare (plans) | $30 | 103% |
| Devoted Health | $30 | 103% |
| Cigna | $30 - $202 | 103% |
| Kansas Health | $30 | 103% |
| Denver Health | $44 - $67 | 151% |
| Direct To Employer | $50 - $114 | 172% |
| Peak Health | $72 - $111 | 248% |
| Centura Employee Plan | $72 | 248% |
| Wpaa | $105 | 361% |
| Christian Health Aid | $120 | 413% |
| Multiplan | $131 - $242 | 451% |
| United Colorado Doctor'S Plan | $143 - $150 | 492% |
| Health Partners Of Kansas | $146 | 502% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, the gross charge at St. Catherine Hospital in Garden City is $184.00. While the facility offers a cash median price of $74.00, which is significantly lower than the state average of $113.00 for negotiated rates, patients should be aware that commercial insurance plans often pay higher amounts due to administrative overhead. For instance, UnitedHealthcare and Multiplan have negotiated ranges extending up to $232 and $242 respectively, which exceed the cash price. This dynamic suggests that patients with high-deductible plans or those seeking immediate cost certainty might find the cash-pay option more advantageous, provided they confirm the facility's "self-pay" or "prompt-pay" discounts before scheduling.
The facility's pricing structure also highlights the importance of understanding balance billing and itemized audits. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected ancillary charges or errors in the summary bill could still lead to higher costs. Given that over 80% of hospital bills contain errors, patients should request a detailed, line-by-line itemized statement rather than accepting a broad summary invoice. Furthermore, the facility's Medicare benchmark of $29.06 serves as a reliable cost baseline; commercial negotiated rates are often 200% to 300% of this amount, whereas fair pricing typically aligns closer to 120% to 150%. To ensure transparency and avoid surprise costs, consumers should verify their deductible status and dispute any discrepancies via certified mail if an itemized audit reveals unbundled codes