Physical therapy (gait training)
Facility: Mcpherson Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $76
- Cash Discount Price: $73
- vs. Medicare Baseline: 2.62x 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 262% of the Medicare baseline (a markup of 162%). 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 |
|---|---|---|
| Tricare | $24 | 83% |
| Blue Cross Blue Shield | $28 | 96% |
| Va Ccn - All Plans | $28 | 96% |
| Humana | $28 | 96% |
| UnitedHealthcare | $28 - $99 | 96% |
| Healthy Blue Mcr Adv | $28 | 96% |
| Wellcare Mcr Adv - All Plans | $28 | 96% |
| Ambetter / Centene | $32 | 110% |
| Wppa - All Plans | $69 | 237% |
| Central Plains - All Plans | $74 | 255% |
| Medical Associates - All Plans | $74 | 255% |
| Christian Health Aid - All Plans | $79 | 272% |
| Aetna | $82 - $99 | 282% |
| Multiplan - All Plans | $89 | 306% |
| First Health - All Plans | $94 | 323% |
| Health Partners - All Plans | $94 | 323% |
| Cigna | $94 | 323% |
| Medicaid / KanCare | $99 | 341% |
| Health Blue Mcaid - All Other Plans | $101 | 348% |
Consumer Guidance & Cost Commentary
For CPT code 97116, Physical therapy (gait training), McPherson Hospital in McPherson, KS, lists a gross charge of $99.00. The facility's cash median rate is $73.00, which is notably lower than the negotiated rates paid by most commercial payers, ranging from $24 to $99 depending on the insurer. While the facility's negotiated median is $76.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $73.00. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40% compared to direct cash payments.
To minimize costs, patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary significantly across the 19 payers listed for this service. If a patient chooses to pay out-of-pocket, they should explicitly request a "self-pay" or "prompt-pay" discount prior to check-in, as hospitals often offer fee reductions for upfront payment to bypass costly claims processing. Additionally, since Medicare sets a benchmark rate of $29.06 for this procedure, the facility's cash rate of $73.00 represents a markup relative to the federal government's cost basis, which is a standard metric for evaluating fair pricing in the healthcare system.