Physical therapy (gait training)
Facility: Labette Health
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $37
- Cash Discount Price: $77
- vs. Medicare Baseline: 1.27x 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 |
|---|---|---|
| Uhccp | $18 | 62% |
| Medicaid / KanCare | $24 - $49 | 83% |
| Healthy Blue | $25 | 86% |
| Ambetter / Centene | $27 - $43 | 93% |
| Montgomery County | $36 | 124% |
| Wellcare | $37 | 127% |
| UnitedHealthcare | $37 - $95 | 127% |
| Humana | $37 | 127% |
| Blue Cross Blue Shield | $37 - $46 | 127% |
| Multiplan | $93 | 320% |
| Health Partners Of Kansas, Inc | $98 | 337% |
| Choicecare (First Health Network) | $98 | 337% |
Consumer Guidance & Cost Commentary
For this physical therapy session (CPT 97116) at Labette Health in Parsons, KS, the cash price of $77.00 is significantly lower than the facility's negotiated rates with major insurers, which range from $18 to $98 depending on the plan. While the facility is a government-owned acute care hospital, patients with high-deductible plans or those without insurance may find the cash price more affordable than their insurance allowed amounts, which can sometimes exceed the cash rate. It is important to note that while the facility offers a cash median of $77.00, the negotiated rates for in-network payers like UnitedHealthcare and Blue Cross Blue Shield can be substantially higher, meaning self-pay or prompt-pay discounts should be requested directly with the hospital before scheduling to ensure the best financial outcome.
The facility's pricing structure also warrants attention regarding balance billing and billing accuracy. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request a full itemized bill to verify that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. When reviewing the final invoice, compare the total charges against the Medicare benchmark of $29.06; commercial negotiated rates often average 200% to 300% of this federal rate, whereas fair pricing is typically defined as 120% to 150%. If you receive a large bill after insurance processing, dispute any discrepancies in writing to the billing supervisor rather than accepting a summary invoice, and always confirm your deductible status before relying on insurance to cover the service.