Physical therapy (gait training)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $58
- Cash Discount Price: $61
- vs. Medicare Baseline: 2.00x 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.
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 | $49 | 169% |
| Humana | $55 | 189% |
| Aetna | $56 - $61 | 193% |
| UnitedHealthcare | $58 | 200% |
| Hpk-All Plans | $58 | 200% |
| Medicaid / KanCare | $61 | 210% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy and gait training, Medicine Lodge Memorial Hospital in Medicine Lodge, Kansas, lists a cash median price of $61.00. This cash rate aligns exactly with the facility's gross charge and is notably higher than the state average, which is $58.00. While commercial insurance carriers like Aetna and UnitedHealthcare have negotiated rates ranging from $55 to $61, patients should be aware that paying cash upfront can sometimes be more cost-effective if their specific insurance plan's negotiated rate exceeds the cash price. Because the facility is a Critical Access Hospital owned by a Government Hospital District, it may offer prompt-pay discounts for self-pay patients who settle their bill in full within a short window, potentially reducing the final amount owed.
To ensure you are receiving the best possible rate, it is crucial to verify your specific insurance plan's allowed amount before scheduling, as in-network status does not guarantee the lowest price. The Medicare benchmark for this service is $29.06, which serves as a reliable baseline for evaluating the facility's pricing markup; the facility's cash rate of $61.00 represents a significant increase over this federal standard. If you have an out-of-network provider or encounter unexpected charges, the No Surprises Act may protect you from balance billing for emergency or non-emergency services at in-network facilities. Always request a detailed, itemized bill before making payment to identify any errors or unbundled codes, and consider asking the billing department about self-pay discounts or prompt-pay options prior to check-in to avoid surprise costs.