Physical therapy (gait training)
Facility: F W Huston Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $77
- Cash Discount Price: $80
- vs. Medicare Baseline: 2.65x 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 265% of the Medicare baseline (a markup of 165%). 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% |
| Aetna | $75 | 258% |
| Humana | $79 | 272% |
| Cigna | $85 | 292% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at F W Huston Medical Center in Winchester, KS, the facility's cash median rate is $80.00, which is notably lower than the state average of $100.00. While the facility's negotiated rates with major payers like Blue Cross Blue Shield, Aetna, Humana, and Cigna range from $46 to $85, these amounts often exceed the cash price. For patients with high-deductible plans, paying the cash rate of $80.00 directly can be more cost-effective than relying on insurance, as the negotiated rates may not cover the full cost of care until deductibles are met. It is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative fees associated with insurance claims.
The facility's negotiated rates are significantly higher than the Medicare benchmark of $29.06, with a markup of 2.6 times the Medicare amount. This disparity highlights that commercial insurance rates often include administrative overhead and contract premiums that do not reflect the true cost of service delivery. To ensure you are receiving fair pricing, it is recommended to request a detailed, itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Additionally, if you are concerned about balance billing, remember that the No Surprises Act protects you from being billed for out-of-network services at in-network facilities, so you should dispute any unexpected charges and request an audit from your insurer before making a