Physical therapy (gait training)
Facility: Pratt Regional Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $87
- Cash Discount Price: $74
- vs. Medicare Baseline: 2.99x 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 299% of the Medicare baseline (a markup of 199%). 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 |
|---|---|---|
| Celtic Insurance Company | $28 | 96% |
| Healthy Blue | $29 | 100% |
| UnitedHealthcare | $31 - $107 | 107% |
| Christian Health Aid | $79 | 272% |
| Health Partners Of Kansas | $89 | 306% |
| Aetna | $95 | 327% |
| Choicecare | $105 | 361% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Pratt Regional Medical Center in Pratt, KS, the cash price is $74.00, which is significantly lower than the facility's gross charge of $105.00. This cash rate is notably lower than the state average, offering a potential savings opportunity for patients with high-deductible plans or those without insurance. While the facility's negotiated rates with major payers like UnitedHealthcare range from $31 to $107, these amounts often exceed the cash price due to administrative costs and contract structures. Patients should verify their specific plan's deductible status before relying on insurance, as paying the negotiated rate may result in higher out-of-pocket costs if the deductible has not been met.
To minimize unexpected costs, patients should proactively request a "self-pay" or "prompt-pay" discount from the billing department, which can reduce the final amount owed. It is also important to understand that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, patients should still review their itemized bills carefully to ensure no unbundled codes or services not rendered are included. Since over 80% of hospital bills contain errors, requesting a formal itemized audit via certified mail is an effective way to identify and correct discrepancies before payment. By comparing the cash rate of $74.00 against the Medicare benchmark of $29.06, patients can see that the cash price represents a reasonable market rate, whereas the gross charges are inflated list prices that should not be paid in full.