Physical therapy (gait training)
Facility: Wamego Health Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $25
- Cash Discount Price: $50
- vs. Medicare Baseline: 0.86x 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 |
|---|---|---|
| Medicaid / KanCare | $23 - $25 | 79% |
| UnitedHealthcare | $24 | 83% |
| Aetna | $25 | 86% |
| Providrs Care | $36 | 124% |
| Blue Cross Blue Shield | $61 - $64 | 210% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Wamego Health Center in Wamego, KS, the cash median price is $50.00, which is significantly lower than the facility's gross charge of $126.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that their insurance negotiated rates vary widely by plan; for instance, Medicaid/KanCare plans pay an average of $23 to $25, whereas Blue Cross Blue Shield plans pay between $61 and $64. Because the cash price of $50.00 is lower than the lowest insurance negotiated rate of $23.00 (which is actually higher than the cash price, indicating a potential discrepancy or specific plan structure where the allowed amount exceeds the cash rate, or conversely, if the cash rate is lower than the allowed amount, the patient might save by paying cash), patients with high-deductible plans may find paying out-of-pocket cheaper than relying on insurance, provided the insurance allowed amount exceeds the cash price. It is crucial to verify the specific "self-pay" or "prompt-pay" discount available at the facility before scheduling, as these upfront discounts can further reduce the final cost.
When evaluating the cost of this service, it is important to understand that commercial insurance rates are often inflated by administrative overhead and contract dynamics, sometimes reaching 200% to 300% of the Medicare benchmark rate of $29.06 for this procedure. The facility's cash rate of $50.00 is higher than the Medicare amount, but lower than the gross charge,