Physical therapy (gait training)
Facility: Ellsworth County Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $61
- Cash Discount Price: $68
- 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 |
|---|---|---|
| Healthy Blue Mcr Adv | $32 | 110% |
| Va Ccn-All Plans | $32 | 110% |
| Triwest -All Plans | $32 | 110% |
| Humana | $32 - $65 | 110% |
| Blue Cross Blue Shield | $44 - $46 | 151% |
| UnitedHealthcare | $44 - $68 | 151% |
| Aetna | $61 | 210% |
| First Health - All Plans | $61 | 210% |
| Cigna | $65 | 224% |
| Coventry Mcaid-All Plans | $68 | 234% |
| Medicaid / KanCare | $68 | 234% |
| Healthy Blue Mcaid- All Other Plans | $68 | 234% |
| Providers Care-Wppa-All Plans | $102 | 351% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, the cash price at Ellsworth County Medical Center is $68.00. This cash rate aligns exactly with the facility's median negotiated rate of $61.00 and the cash median across all payers. While the facility is a Critical Access Hospital in Ellsworth, Kansas, with a facility rating of 2, the specific pricing data provided does not include explicit state or county average figures for comparison. However, the facility's cash price is notably higher than the Medicare benchmark of $29.06, which serves as the federal baseline for this service. Patients should be aware that while commercial insurance contracts often cap charges at negotiated rates, these amounts can sometimes exceed the cash price, making self-pay a potentially more affordable option for those with high-deductible plans or those who can secure prompt-pay discounts.
The facility's billing structure reflects standard industry dynamics where administrative costs and contract management inflate the baseline price above the true cost of care. The Medicare amount of $29.06 highlights that commercial rates, even when discounted, often represent a markup relative to the federal government's cost-based reimbursement. To minimize costs, patients are encouraged to verify their specific plan's allowed amount before scheduling, as in-network rates vary significantly by carrier. It is also important to request a waiver of insurance submission prior to check-in to ensure the facility applies its self-pay or prompt-pay discount, which can bypass the administrative overhead associated with claims processing. Finally, if a bill is received, patients should request a full itemized statement to review every CPT code and unit charge, as over 80% of hospital bills contain errors that