Physical therapy (gait training)
Facility: University Of Ks Hlth System Great Bend Campus
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $85
- Cash Discount Price: $28
- vs. Medicare Baseline: 2.92x 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 292% of the Medicare baseline (a markup of 192%). 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 |
|---|---|---|
| Workers Comp [503999901] | $27 - $120 | 93% |
| Ku Athletics [503200094] | $27 | 93% |
| Humana | $27 | 93% |
| UnitedHealthcare | $27 - $92 | 93% |
| Allwell [503200078] | $28 | 96% |
| Medicare (plans) | $28 | 96% |
| Blue Cross Blue Shield | $28 | 96% |
| Centurion [5032000966] | $36 | 124% |
| Ambetter / Centene | $40 | 138% |
| Wppa [503200056] | $59 | 203% |
| Meritain Health [503200039] | $59 - $85 | 203% |
| Alt Wppa [5032000964] | $59 | 203% |
| 6 Degrees Health [503999050] | $68 | 234% |
| Alt Carelon Behavioral Health [503200905] | $70 | 241% |
| Advanced Medical Pricing Solutions [503301513] | $82 | 282% |
| Php [503200005] | $85 | 292% |
| Aha-Healthcare Preferred [503200050] | $85 | 292% |
| Cigna | $85 - $113 | 292% |
| Alt Meritain Health [503999911] | $85 | 292% |
| Allied National [503999937] | $85 | 292% |
| Aetna | $85 | 292% |
| National Assn Letter Carriers [503200019] | $85 | 292% |
| First Health [5032000110] | $85 | 292% |
| Occunet [503999930] | $90 | 310% |
| Fort Hays State Student Athletes [5032000960] | $90 | 310% |
| Geha [503200036] | $92 | 317% |
| Medica [503200074] | $92 | 317% |
| Correct Care Solutions [50311253] | $99 | 341% |
| Usa Managed Care [503999030] | $127 | 437% |
| Hchsync Centrus Health Direct [503999916] | $130 - $150 | 447% |
Consumer Guidance & Cost Commentary
For this physical therapy service at the University of KS Health System Great Bend Campus, the cash price is $28.00, which is significantly lower than the facility's gross charge of $141.00. While the facility's negotiated rates with insurance payers range from $27 to $150, the cash price of $28.00 is notably lower than the state average for this procedure. Patients with high-deductible plans or those without insurance may find that paying the cash price directly is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final cost.
The facility's Medicare benchmarking rate is $29.06, which serves as a reliable baseline for evaluating pricing fairness. The commercial negotiated rates observed in this data, averaging $85.00, are substantially higher than the Medicare rate, reflecting the administrative costs and contract structures inherent in insurance billing. Because the No Surprises Act prohibits balance billing for out-of-network providers at in-network facilities, patients should be cautious of unexpected bills and should always request an itemized statement to verify that all charges align with the allowed amount. If a patient receives a bill exceeding the negotiated rate, they should dispute it in writing with the billing supervisor rather than accepting a summary invoice, ensuring they are not overcharged for services rendered.