Physical therapy (gait training)
Facility: Jewell County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $91
- Cash Discount Price: $72
- vs. Medicare Baseline: 3.13x 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 313% of the Medicare baseline (a markup of 213%). 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 |
|---|---|---|
| Rural Carriers - All Plans | $82 | 282% |
| Aetna | $86 | 296% |
| Meritain - All Plans | $86 | 296% |
| First Health - All Plans | $91 | 313% |
| Midlands Choice - All Plans | $91 | 313% |
| Cigna | $91 | 313% |
| UnitedHealthcare | $91 | 313% |
Consumer Guidance & Cost Commentary
For the CPT code 97116 (Physical therapy, gait training), the gross charge at Jewell County Hospital in Mankato, KS, is $96.00. While the facility's cash median rate is $72.00, the negotiated rates paid by major payers such as Aetna, Meritain, and Cigna are $86.00 to $91.00. It is important to note that for patients with high-deductible plans, paying the cash price of $72.00 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price. Additionally, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed by paying in full before or shortly after the service is rendered.
The facility's pricing structure is evaluated against federal benchmarks to ensure transparency. The Medicare amount for this service is $29.06, which serves as the objective baseline for evaluating the facility's markup. Commercial negotiated rates typically range from 200% to 300% of Medicare, though fair pricing is often defined as 120% to 150% of the Medicare rate. In this case, the median negotiated rate of $91.00 reflects the contractual agreements between the hospital and insurers. Patients should be aware that balance billing is generally prohibited for out-of-network services at in-network facilities under the No Surprises Act, but it is crucial to request a full itemized bill to identify any errors, unbundled codes, or services not rendered before finalizing payment.