Physical therapy (gait training)
Facility: Cheyenne County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $72
- Cash Discount Price: $76
- vs. Medicare Baseline: 2.48x 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 248% of the Medicare baseline (a markup of 148%). 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 | $46 | 158% |
| First Health - All Plans | $53 | 182% |
| Tricare | $55 | 189% |
| Healthy Blue Mcr Adv | $55 | 189% |
| Choice Care - All Plans | $55 | 189% |
| Aetna | $55 - $72 | 189% |
| UnitedHealthcare | $55 - $230 | 189% |
| Firstguard - All Plans | $61 | 210% |
| Wppa - All Plans | $68 | 234% |
| Preferred Hc - All Plans | $72 | 248% |
| Cpm - All Plans | $72 | 248% |
| Ppo Next - All Plans | $74 | 255% |
| Integrated Hp - All Plans | $74 | 255% |
| Midlands Choice - All Plans | $74 | 255% |
| Unicare - All Plans | $74 | 255% |
| Health Partners - All Plans | $74 | 255% |
| Childrens Mercy - All Plans | $76 | 262% |
| Healthy Blue Mcaid - All Other Plans | $76 | 262% |
| Healthwave Mcaid - All Plans | $76 | 262% |
| Providers Care-All Plans | $114 | 392% |
Consumer Guidance & Cost Commentary
For CPT code 97116, Physical therapy (gait training), Cheyenne County Hospital lists a cash price of $76.00, which matches the facility's cash median. This rate is significantly higher than the Medicare benchmark of $29.06, indicating a markup of 2.5 times the federal baseline. While the facility's negotiated rates with insurance payers range from $46 to $230, the cash price may actually be the most cost-effective option for patients with high-deductible plans or those without insurance, as the cash rate is lower than many of the negotiated amounts paid by commercial insurers. Patients should verify their specific plan's allowed amount, as some insurance contracts may result in higher out-of-pocket costs than paying the cash price directly.
To minimize potential surprise costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling services, as these upfront fee reductions can lower the final bill by 20% to 50%. If you do use insurance, be aware that balance billing could occur if an out-of-network provider bills you for the difference between their full chargemaster rate and your insurer's allowed amount, though the No Surprises Act protects you from such charges for emergency care and non-emergency services at in-network facilities. Additionally, if you receive a summary bill, request a full itemized audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies that can be corrected through a formal written dispute.