Physical therapy (gait training)
Facility: Kearny County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $99
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.41x 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 341% of the Medicare baseline (a markup of 241%). 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 |
|---|---|---|
| UnitedHealthcare | $99 | 341% |
| Blue Cross Blue Shield | $99 | 341% |
| Cigna | $99 | 341% |
| Wps Gha - Mac J5 Part A | $99 | 341% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, the facility in Lakin, KS, charges a gross list price of $99.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Blue Cross Blue Shield are also $99.00, the median amount actually paid by insurers is significantly lower at $59.00. This indicates that while insurance contracts cap the billed amount, the final reimbursement varies. It is important to note that cash-pay rates are not listed for this service, but patients with high-deductible plans should be aware that paying out-of-pocket might be more cost-effective if the insurance negotiated rate exceeds the cash price, though in this specific case, the cash price is unavailable for comparison.
Patients should be cautious regarding balance billing, as the No Surprises Act generally protects against unexpected bills for out-of-network providers at in-network facilities, though emergency ancillary services may still trigger such charges. If you receive a bill, always request a full itemized statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, while the facility is a Critical Access Hospital with government ownership, you should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the total cost by bypassing administrative fees and insurance claim processing delays.