Physical therapy (gait training)
Facility: Ashland Health Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $95
- Cash Discount Price: $76
- vs. Medicare Baseline: 3.27x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 327% of the Medicare baseline (a markup of 227%). 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 | $32 | 110% |
| Compalliance-All Plans | $76 | 262% |
| Health Partners Of Kansas-All Plans | $81 | 279% |
| Multiplan-All Plans | $93 | 320% |
| Health Choice-All Plans | $95 | 327% |
| Medica Mcare - All Plans | $95 | 327% |
| Aetna | $95 | 327% |
| Medicare (plans) | $95 | 327% |
| Healthy Blue Mcr Adv - All Other Plans | $95 | 327% |
| Medicaid / KanCare | $95 | 327% |
| UnitedHealthcare | $95 | 327% |
| Providers Care (Wppa)-All Plans | $142 | 489% |
Consumer Guidance & Cost Commentary
For CPT code 97116, Physical therapy (gait training), the facility's negotiated rate is $95.00, which matches the gross chargemaster price. This rate is significantly higher than the cash median of $76.00, meaning patients paying out-of-pocket could save $19.00 compared to the facility's standard billing. While the facility is a Critical Access Hospital in Ashland, KS, the data does not provide specific county or state average rates for comparison. However, the presence of multiple payers with identical negotiated rates of $95.00 suggests a uniform pricing structure across the network, including Medicaid/KanCare and UnitedHealthcare.
Patients should be aware that while insurance often negotiates a ceiling rate, the cash price can sometimes be lower, particularly for those with high-deductible plans where the insurance allowed amount might exceed the cash price. To minimize costs, individuals should contact the facility directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. Additionally, if a balance bill arises from an out-of-network service, patients should verify the legality of the charge under the No Surprises Act before paying, and always request a full itemized bill to ensure no unbundled codes or services not rendered are included.