Physical therapy (gait training)
Facility: Ellinwood District Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $49
- Cash Discount Price: $60
- vs. Medicare Baseline: 1.69x 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 |
|---|---|---|
| Aetna | $49 | 169% |
| Cigna | $49 | 169% |
| Blue Cross Blue Shield | $49 | 169% |
| UnitedHealthcare | $49 | 169% |
| Humana | $49 | 169% |
Consumer Guidance & Cost Commentary
For CPT code 97116, Physical therapy (gait training), at Ellinwood District Hospital in Ellinwood, KS, the facility's cash median rate is $60.00, while the negotiated rate paid by major insurers like Aetna, Cigna, and UnitedHealthcare is $49.00. This indicates that for patients with high-deductible plans, paying cash directly might be more cost-effective than using insurance, as the negotiated rate exceeds the cash price. However, patients should verify if their specific plan has a deductible or copay that could result in a higher out-of-pocket cost than the $60.00 cash rate. Additionally, Ellinwood District Hospital is a Critical Access Hospital owned by a Government Hospital District, and while the data does not provide specific county or state average comparisons for this procedure, the facility's location in ZIP code 67526 is relevant for understanding regional pricing benchmarks.
It is important to note that the $49.00 negotiated rate represents the maximum amount insurers are contractually allowed to pay, which is lower than the facility's gross chargemaster price of $70.00 but higher than the cash rate. If you choose to use insurance, be aware that balance billing is generally prohibited for in-network services at this facility under the No Surprises Act, meaning you will not be billed for the difference between the $70.00 list price and the $49.00 allowed amount. To ensure you receive the best possible price, we recommend asking the hospital registration desk about "self-pay" or "prompt-pay" discounts before scheduling your visit, as paying in full upfront can