Physical therapy (gait training)
Facility: Kiowa District Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $86
- Cash Discount Price: $73
- vs. Medicare Baseline: 2.96x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 296% of the Medicare baseline (a markup of 196%). 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 |
|---|---|---|
| Tricare | $35 | 120% |
| Healthchoice-All Plans | $45 | 155% |
| Blue Cross Blue Shield | $46 | 158% |
| UnitedHealthcare | $73 - $91 | 251% |
| Health Partners Of Ks-All Plans | $80 | 275% |
| Humana | $82 | 282% |
| Multiplan-All Plans | $86 | 296% |
| Gbs Insurance - All Plans | $86 | 296% |
| Triwest-All Plans | $86 | 296% |
| Medicare (plans) | $86 | 296% |
| Aetna | $86 | 296% |
| Medicaid / KanCare | $91 | 313% |
| Providers Care (Wppa)-All Plans | $136 | 468% |
| Liberty Healthshare-All Plans | $147 | 506% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy (gait training), the facility's cash median rate is $73.00, which is lower than the negotiated rates paid by most commercial payers. While the gross chargemaster lists at $91.00, patients with high-deductible plans may find the cash price more affordable if their insurance negotiated rate exceeds this amount. It is important to note that commercial payers like UnitedHealthcare and Providers Care have negotiated rates ranging from $73.00 to $147.00, which are significantly higher than the cash option. To minimize costs, patients should verify their specific plan's allowed amount before scheduling and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront.
This service is provided at Kiowa District Hospital, a Critical Access Hospital in Kiowa, Kansas, where the Medicare benchmark rate for this procedure is $29.06. The facility's cash rate of $73.00 represents a markup of approximately 151% over the Medicare amount, which aligns with the typical range of 120% to 150% considered fair pricing. Since the facility is a government-owned hospital district, balance billing for out-of-network services is less likely, though patients should still review their itemized bills to ensure no unbundled codes or services not rendered are included. If you receive a summary bill, request a full itemized statement to identify any errors, as over 80% of hospital bills contain discrepancies that can be corrected through a formal