Physical therapy (gait training)
Facility: Logan County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $81
- Cash Discount Price: $19
- vs. Medicare Baseline: 2.79x 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 279% of the Medicare baseline (a markup of 179%). 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 |
|---|---|---|
| Humana | $36 - $42 | 124% |
| Blue Cross Blue Shield | $46 | 158% |
| Health Partners - All Plans | $81 - $95 | 279% |
| Medicaid / KanCare | $85 - $100 | 292% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy (gait training), Logan County Hospital in Oakley, KS, lists a gross charge of $93.00. The facility's cash median rate is $19.00, which is significantly lower than the negotiated rates paid by commercial payers such as Humana ($36–$42) and Health Partners ($81–$$95). This disparity highlights a common billing dynamic where cash-pay options can be substantially cheaper than insurance negotiated rates, particularly for patients with high-deductible plans who may not yet have met their out-of-pocket thresholds. While the facility is a Critical Access Hospital with government-local ownership, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment incentives can further reduce the final cost by bypassing administrative claim processing fees.
When evaluating the facility's pricing against federal benchmarks, the Medicare amount for this service is $29.06. The facility's cash rate of $19.00 falls below the Medicare benchmark, whereas the median negotiated rate of $81.00 exceeds it by a factor of nearly three. This suggests that while the facility's cash pricing is competitive and potentially more favorable than the standard commercial negotiated rates, patients should be cautious about assuming that in-network coverage automatically results in the lowest possible price, as some in-network contracts may still exceed cash options. To ensure transparency and avoid unexpected costs, consumers are encouraged to request an itemized bill before payment and to confirm that no balance billing will occur, as federal protections generally prevent providers from charging the difference between the chargemaster and the insurance allowed amount for services