Physical therapy (gait training)
Facility: Grisell Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $120
- Cash Discount Price: $131
- vs. Medicare Baseline: 4.13x 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 413% of the Medicare baseline (a markup of 313%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $44 | 151% |
| UnitedHealthcare | $103 - $138 | 354% |
| Medicaid / KanCare | $138 | 475% |
| Humana | $138 | 475% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, Physical therapy (gait training), at Grisell Memorial Hospital in Ransom, Kansas, the facility's cash median price is $131.00, which is slightly lower than the negotiated rates paid by major payers like UnitedHealthcare ($103–$138) and Blue Cross Blue Shield ($44). While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that commercial insurance often results in higher out-of-pocket costs than paying cash directly. If your insurance plan has a high deductible, paying the cash price of $131.00 upfront could save you money compared to the negotiated rate your insurer might apply, which includes administrative overhead and claims processing costs.
To ensure you are not overcharged, it is advisable to request a prompt-pay discount from the hospital before scheduling your visit, as these discounts can reduce the final bill by 20% to 50% when paid in full. Additionally, if you receive a bill from an out-of-network provider or for services not rendered, you should request an itemized billing audit to identify errors such as double-billing or unbundled codes, which are common in hospital billing. Finally, always compare the facility's rates to the Medicare benchmark of $29.06 for this service; commercial rates are often significantly higher than this federal baseline, so verifying the allowed amount with your insurer before treatment can help you understand the true cost relative to the state average.