Physical therapy (gait training)
Facility: Wichita County Health Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $59
- Cash Discount Price: $52
- vs. Medicare Baseline: 2.03x 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 203% of the Medicare baseline (a markup of 103%). 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 |
|---|---|---|
| Medicaid / KanCare | $49 - $58 | 169% |
| UnitedHealthcare | $59 - $71 | 203% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Wichita County Health Center in Leoti, KS, has a cash median price of $52.00 and a median negotiated rate of $59.00. This cash price is notably lower than the facility's Medicare benchmark of $29.06, indicating that the cash rate exceeds the federal cost baseline. While the facility is a Critical Access Hospital with government-local ownership, patients should be aware that commercial insurance plans like Medicaid/KanCare and UnitedHealthcare negotiate rates ranging from $49.00 to $71.00, which often surpass the cash-pay option. In scenarios where a patient has a high deductible or limited out-of-pocket funds, paying the cash price directly can result in significant savings compared to the insurance negotiated rate, provided the patient's plan does not cover the service.
To ensure you receive the most accurate pricing, it is essential to request an itemized billing audit before finalizing payment, as summary bills may obscure individual charges or unbundled services. If you choose to use insurance, remember that the negotiated rate acts as a contractual ceiling, but administrative processing fees can inflate the final amount billed to your account. Additionally, ask the billing department about prompt-pay discounts, which can reduce the cash balance by 20% to 50% if settled upfront, effectively bypassing the higher administrative costs associated with insurance claims. Always verify your specific plan's allowed amount and deductible status prior to scheduling to avoid unexpected out-of-pocket expenses.