Physical therapy (gait training)
Facility: Stafford County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $73
- Cash Discount Price: $73
- vs. Medicare Baseline: 2.51x 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 251% of the Medicare baseline (a markup of 151%). 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 |
|---|---|---|
| Health Partners-All Plans | $69 | 237% |
| Medica Mcr- All Plans | $73 | 251% |
| Va Ccn-All Plans | $73 | 251% |
| UnitedHealthcare | $73 | 251% |
| Humana | $73 | 251% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy (gait training), the cash median price at Stafford County Hospital is $73.00, which matches the negotiated rates across all five listed payers, including Health Partners-All Plans, Medica Mcr- All Plans, and UnitedHealthcare. This facility, a Critical Access Hospital in Stafford, KS, does not offer a lower cash price than its commercial negotiated rates, meaning patients with high-deductible plans may find paying out-of-pocket directly to the hospital the most cost-effective option, as the insurance allowed amount does not exceed the cash price. While the facility is government-owned locally, the pricing structure here aligns the self-pay rate with the insurer's ceiling, eliminating the potential for balance billing on this specific service if the patient chooses to pay cash directly.
The Medicare benchmark for this procedure is $29.06, indicating that the commercial rates at this facility are significantly higher than the federal baseline, which is typical for commercial contracts that include administrative overhead and network tiering factors. Because the cash price of $73.00 is identical to the negotiated rates, there is no additional administrative burden for patients to seek prompt-pay discounts or itemized audits for this specific line item, as the facility has already applied its standard pricing. Consumers should verify their specific plan's deductible status before scheduling, as the $73.00 amount represents the full allowed charge that would be billed to the patient if their insurance has not yet met its deductible threshold.