Physical therapy (gait training)
Facility: Rooks County Health Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $86
- Cash Discount Price: $72
- vs. Medicare Baseline: 2.96x 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 296% of the Medicare baseline (a markup of 196%). 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 |
|---|---|---|
| Celtic Mcr Adv | $45 | 155% |
| Veterans Admin - All Plans | $45 | 155% |
| Tricare | $45 | 155% |
| Blue Cross Blue Shield | $46 | 158% |
| Celtic Comm - All Other Plans | $50 | 172% |
| UnitedHealthcare | $86 | 296% |
| Aetna | $86 | 296% |
| Preferred Benefits Admin | $86 | 296% |
| Preferred Hlthcare - All Other Plans | $91 | 313% |
| Health Partners - All Plans | $91 | 313% |
| Healthy Blue Mcaid - All Plans | $96 | 330% |
Consumer Guidance & Cost Commentary
For the CPT code 97116 (Physical therapy, gait training), Rooks County Health Center in Plainville, KS, lists a cash median price of $72.00, which is lower than the facility's negotiated rates of $86.00 paid by most major payers. While the facility is a Critical Access Hospital with government ownership, patients should note that cash payments may not always be the cheapest option if their insurance deductible has not yet been met. In such cases, paying the negotiated rate of $86.00 through an in-network plan like Celtic Mcr Adv or Veterans Admin might be more cost-effective than paying the lower cash price, as the patient would avoid out-of-pocket expenses until their deductible is satisfied. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the total cost.
The facility's gross charge for this service is $96.00, which serves as the baseline before any insurance negotiations or cash discounts are applied. It is important to understand that commercial insurance rates often exceed cash prices due to the administrative costs of claims processing and contract management, which can inflate the baseline price by 20% to 40%. If a patient receives care from an out-of-network provider or encounters unexpected ancillary services, they could face balance billing for the difference between the full chargemaster rate and what their insurance allows, though the No Surprises Act provides federal protections against surprise bills for emergency and non-emergency services at in-network facilities. To ensure accuracy and avoid errors, patients should request a full itemized bill that breaks down every CPT code and