Physical therapy (gait training)
Facility: Meade District Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $61
- Cash Discount Price: $61
- vs. Medicare Baseline: 2.10x 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 210% of the Medicare baseline (a markup of 110%). 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 | $61 | 210% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, "Physical therapy (gait training)," Meade District Hospital in Meade, KS, lists a cash price of $61.00. This cash rate matches the negotiated rate for Blue Cross Blue Shield, which is the only payer in this dataset, and aligns with the median negotiated amount of $61.00. While the facility is a Critical Access Hospital with government ownership, the cash price is notably higher than the Medicare benchmark of $29.06, reflecting a markup typical of commercial pricing structures. Patients with high-deductible plans may find paying the full $61.00 upfront more cost-effective than relying on insurance, as the negotiated rate often exceeds the cash price due to administrative overheads.
To minimize potential costs, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. It is also important to understand that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, patients should still request an itemized bill to ensure no unbundled charges or services not rendered are included. Since over 80% of hospital bills contain errors, reviewing the line-by-line statement before payment is a critical step to avoid unexpected debt, and any disputes should be handled in writing rather than through verbal agreements.