Physical therapy (gait training)
Facility: Clara Barton Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $73
- Cash Discount Price: $57
- vs. Medicare Baseline: 2.51x 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 251% of the Medicare baseline (a markup of 151%). 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 | 158% |
| 6 Degrees Health - All Plans | $57 | 196% |
| Wppa-All Plans | $65 | 224% |
| Phcs - All Plans | $73 | 251% |
| UnitedHealthcare | $73 | 251% |
| Aetna | $73 | 251% |
| Hlth Partners Of Ks-All Plans | $75 | 258% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Clara Barton Hospital in Hoisington, KS, the cash median price is $57.00, which is lower than the negotiated rates of $73.00 paid by most major payers including Blue Cross Blue Shield, UnitedHealthcare, and Aetna. This facility is a Critical Access Hospital with a voluntary non-profit ownership structure, and while the cash price is notably lower than the commercial negotiated rates, it remains significantly higher than the Medicare benchmark of $29.06. In this specific case, the cash price is approximately 2.5 times the Medicare amount, illustrating that for patients with high-deductible plans, paying out-of-pocket might be more cost-effective than relying on insurance, which would result in a higher allowed amount of $73.00.
Patients should be aware that hospitals often issue summary bills that obscure individual line items, making it difficult to identify errors or unbundled charges; therefore, requesting a full itemized CPT-coded statement before payment is the most effective way to audit the bill and reduce potential medical debt. Additionally, since the facility offers a prompt-pay discount for upfront payments, patients should contact the billing department prior to scheduling to confirm self-pay rates and request a waiver of insurance submission to avoid automatic claims processing that could void any cash savings. Given that the facility is located in a rural area with a specific Medicare benchmark, comparing the final allowed amount to the state average ensures transparency, though the data provided does not include explicit county or state average figures for this specific procedure.