Physical therapy (gait training)
Facility: Nemaha Valley Community Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $49
- Cash Discount Price: $87
- vs. Medicare Baseline: 1.69x 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.
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 |
|---|---|---|
| Va Ccn - All Plans | $43 | 148% |
| Aetna | $43 - $82 | 148% |
| Humana | $43 | 148% |
| Blue Cross Blue Shield | $46 | 158% |
| Celtic Comm Exch - All Plans | $47 | 162% |
| Partners Direct Health - All Plans | $50 | 172% |
| Multiplan - All Plans | $87 | 299% |
| Midlands Choice - All Plans | $92 | 317% |
| Health Partners - All Plans | $92 | 317% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy (gait training), Nemaha Valley Community Hospital in Seneca, KS, lists a cash median price of $87.00. This cash rate is notably higher than the state of Kansas average, which is $50.00. While commercial insurance negotiated rates vary by plan, ranging from $43 to $92, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $87.00. It is important to note that commercial rates often include administrative overhead and do not reflect the true cost of care, which is better represented by the Medicare benchmark of $29.06.
Patients should be aware that commercial insurance contracts often result in higher out-of-pocket costs than direct cash payment due to the administrative burden of claims processing. Before scheduling, it is advisable to request a "self-pay" or "prompt-pay" discount, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if you receive a bill from an out-of-network provider at this facility, the No Surprises Act may protect you from balance billing for emergency or non-emergency services. If you do receive an unexpected bill, do not pay immediately; instead, request a formal itemized audit to identify errors such as unbundled codes or services not rendered, as over 80% of hospital bills contain inaccuracies.