Physical therapy (gait training)
Facility: Hamilton County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $84
- Cash Discount Price: $93
- vs. Medicare Baseline: 2.89x 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 289% of the Medicare baseline (a markup of 189%). 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 | $22 - $46 | 76% |
| First Health Coventry - All Plans | $79 | 272% |
| Cigna | $88 | 303% |
| UnitedHealthcare | $88 | 303% |
| Va Ccn - All Plans | $93 | 320% |
| Aetna | $158 | 544% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Hamilton County Hospital in Syracuse, KS, lists a cash median price of $93.00, which matches the gross charge. This cash rate is significantly higher than the state average for this service, which is $43.00. While commercial payers like Aetna negotiate a rate of $158.00, the cash price may be more advantageous for patients with high-deductible plans, as the insurance negotiated rate often exceeds the cash price. Patients should verify their specific plan's deductible status before scheduling, as paying the full negotiated amount upfront could result in higher out-of-pocket costs compared to paying the lower cash rate.
To ensure you are receiving the most accurate pricing, it is important to request an itemized bill rather than accepting a summary invoice, as hospitals may obscure individual charges. If you receive a large bill after insurance processing, you should check for prompt-pay discounts, which can reduce the total by 20% to 50% if paid in full within a short window. Additionally, while the Medicare benchmark for this service is $29.06, commercial rates often run 200% to 300% of this amount; however, the facility's negotiated rates average $84.00, which is lower than the highest payer rates but still above the cash option. Always confirm with the hospital whether your specific plan qualifies for self-pay or prompt-pay discounts before finalizing payment.