Physical therapy (gait training)
Facility: Graham County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $57
- Cash Discount Price: $74
- vs. Medicare Baseline: 1.96x 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 |
|---|---|---|
| Medicaid / KanCare | $39 | 134% |
| UnitedHealthcare | $39 - $70 | 134% |
| Blue Cross Blue Shield | $46 | 158% |
| Medicare (plans) | $56 | 193% |
| Celtic Commercial-All Other Plans | $61 | 210% |
| Wppa (Providers Care)-All Plans | $70 | 241% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Graham County Hospital in Hill City, Kansas, the cash price is $74.00. This cash rate is notably higher than the median negotiated rate of $57.00 and the median paid amount of $61.00, suggesting that patients with high-deductible plans might save money by paying cash upfront rather than relying on insurance, which often processes claims at higher administrative costs. While the facility is a Critical Access Hospital owned by the local government, the cash price remains consistent across all six payers listed, ranging from Medicaid/KanCare at $39 to WPPA (Providers Care) at $70, indicating that the negotiated ceiling varies significantly by insurer but the cash option remains a stable baseline.
To minimize unexpected costs, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling any services, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly insurance claims processing. It is also important to note that while the facility's gross charge is $74.00, the Medicare benchmark for this service is $29.06, which serves as a scientifically validated baseline for fair pricing; commercial rates often exceed this by a significant margin due to administrative overhead and contract dynamics. Consumers are advised to avoid accepting summary bills without a full itemized audit, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered, and to dispute any balance billing immediately if it arises from out-of-network ancillary services, utilizing the protections offered by the No Surprises Act