Physical therapy (gait training)
Facility: Kiowa County Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $85
- Cash Discount Price: $81
- vs. Medicare Baseline: 2.92x 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 292% of the Medicare baseline (a markup of 192%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $46 - $85 | 158% |
| UnitedHealthcare | $76 - $95 | 262% |
| Health Partners Of Ks-All Plans | $84 | 289% |
| Aetna | $85 | 292% |
| Humana | $85 | 292% |
| Medica Prime Mcare Cost-All Plans | $85 | 292% |
| Celtic Comml Exchange-All Other Plans | $85 | 292% |
| Medicaid / KanCare | $95 | 327% |
| Providrs Care/Wppa-All Plans | $142 | 489% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Kiowa County Memorial Hospital in Greensburg, KS, the facility's cash median rate is $81.00, while the median negotiated rate paid by insurance is $85.00. This data indicates that for patients with high-deductible plans, paying cash directly may result in lower out-of-pocket costs compared to using insurance, as the negotiated rate exceeds the cash price. The facility is a Critical Access Hospital owned by the local government, and while the specific county and state average comparisons are not provided in this dataset, patients should verify their specific plan's allowed amount, which may vary between the low of $46 and high of $142 depending on the payer. It is important to note that commercial rates often include administrative overhead, and fair pricing benchmarks typically range between 120% and 150% of the Medicare amount of $29.06 for this service.
Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur if ancillary services like labs or emergency physicians are out-of-network. If a patient receives a surprise bill, they should dispute it in writing with the insurer rather than paying immediately, and they should refuse to sign any consent waivers that waive their rights to dispute out-of-network costs. Additionally, since hospitals often issue summary bills that obscure individual charges, consumers should request a full itemized audit to identify errors, unbundled codes, or services not rendered before finalizing payment. Finally, patients should proactively ask the hospital about self-pay or prompt