Physical therapy (gait training)
Facility: Centura St. Catherine-Dodge City
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $99
- Cash Discount Price: $60
- vs. Medicare Baseline: 3.41x 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 341% of the Medicare baseline (a markup of 241%). 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 |
|---|---|---|
| Aetna | $30 - $120 | 103% |
| Blue Cross Blue Shield | $30 - $55 | 103% |
| Humana | $30 | 103% |
| Kaiser | $30 | 103% |
| Kansas Health | $30 | 103% |
| Medicare (plans) | $30 | 103% |
| Cigna | $30 | 103% |
| Centura Employee Plan | $72 | 248% |
| UnitedHealthcare | $99 | 341% |
| Wpaa | $105 | 361% |
| Multiplan | $120 - $136 | 413% |
| Christian Health Aid | $120 | 413% |
| Health Partners Of Kansas | $136 | 468% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, the gross charge at Centura St. Catherine-Dodge City is $151.00. This amount is significantly higher than the Medicare benchmark of $29.06, which serves as the federal baseline for the true cost of this service. While the facility's median negotiated rate across 13 payers is $99.00, patients should be aware that commercial insurance rates often include administrative overhead and contract dynamics that inflate the price beyond the actual cost of care. The cash median price of $60.00 is notably lower than both the negotiated average and the gross charge, illustrating that paying out-of-pocket can sometimes result in a lower total cost, particularly for those with high-deductible plans where insurance reimbursement might not cover the full negotiated amount.
To optimize costs, patients are encouraged to verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront payment incentives can bypass the administrative layers that drive up insurance rates. Although the facility is located in Dodge City, KS, the provided data does not include specific county or state average comparisons for this procedure, so local market benchmarks cannot be referenced here. Regardless of insurance status, it is advisable to request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected through a formal audit dispute.