Physical therapy (gait training)
Facility: Nmc Health
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $45
- Cash Discount Price: $46
- vs. Medicare Baseline: 1.55x 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 |
|---|---|---|
| Bluestem Pace | $28 | 96% |
| Wppa | $29 - $45 | 100% |
| Occunet | $31 - $49 | 107% |
| Medincrease Health Plan | $34 - $53 | 117% |
| Samaritan Ministries International | $34 - $53 | 117% |
| Prime Health Services | $39 - $61 | 134% |
| Medicaid / KanCare | $44 | 151% |
| Leading Age | $44 | 151% |
| Blue Cross Blue Shield | $46 | 158% |
| UnitedHealthcare | $47 - $73 | 162% |
| Cigna | $49 - $77 | 169% |
| Aetna | $55 - $67 | 189% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Nmc Health in Newton, Kansas, the facility's cash median rate is $46.00. This cash price is notably lower than the state average for this service, which is $55.00, and also lower than the facility's own negotiated rates with major payers like UnitedHealthcare ($47–$73) and Cigna ($49–$77). While commercial insurance contracts often result in higher allowed amounts due to administrative overhead and network tiering, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $46.00. To maximize savings, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final cost.
It is important to distinguish between the facility's gross charge of $66.00 and the actual rates patients will face. The gross charge serves as a baseline reference but is not the amount billed to most patients; instead, commercial payers utilize negotiated rates that cap the charge, while Medicare uses a fixed benchmark of $29.06. Because commercial negotiated rates frequently exceed the Medicare benchmark by a significant margin, comparing your specific insurance allowed amount to the Medicare rate provides a clearer picture of the facility's pricing markup. If you receive a bill that appears to include charges for services not rendered or items that were bundled into a single code, you should request a full itemized audit to ensure accuracy, as over 80% of hospital bills contain errors that can be resolved through a formal written dispute