Physical therapy (gait training)
Facility: Stevens County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $59
- Cash Discount Price: $68
- vs. Medicare Baseline: 2.03x 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 203% of the Medicare baseline (a markup of 103%). 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 |
|---|---|---|
| Humana | $25 | 86% |
| Aetna | $26 - $68 | 89% |
| Blue Cross Blue Shield | $44 - $46 | 151% |
| First Health - All Plans | $61 | 210% |
| Wppa - All Plans | $64 | 220% |
| Medicaid / KanCare | $68 | 234% |
Consumer Guidance & Cost Commentary
For the CPT code 97116 (Physical therapy, gait training) at Stevens County Hospital in Hugoton, Kansas, the cash price is $68.00, which matches the facility's negotiated rate for Medicaid/KanCare and the cash median. While the facility's negotiated rate of $59.00 is lower than the cash price, it is important to note that cash-pay can sometimes be cheaper for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price. In this specific case, the cash price aligns with the cash median, but patients should verify their specific plan's allowed amount, as some commercial payers like Aetna have a wide range of negotiated rates ($26 to $68) across different plans.
The facility's negotiated rate of $59.00 is significantly lower than the Medicare benchmark of $29.06, indicating a markup relative to the federal government's cost-based reimbursement. This pricing structure is typical for Critical Access Hospitals, which operate under specific federal rules designed to keep costs low for rural communities. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not eliminate the possibility of unexpected costs if ancillary services are billed separately. To minimize out-of-pocket expenses, patients are encouraged to request a self-pay or prompt-pay discount directly from the hospital before scheduling, as these upfront payment incentives can bypass the administrative costs associated with insurance claims processing.