Physical therapy (gait training)
Facility: Great Plains Of Sabetha
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $61
- Cash Discount Price: $64
- vs. Medicare Baseline: 2.10x 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 210% of the Medicare baseline (a markup of 110%). 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 |
|---|---|---|
| Celtic Mcr Adv | $33 | 114% |
| Aetna | $34 - $65 | 117% |
| Celtic Comm Exchange-All Other Plans | $42 | 145% |
| Great West Healthcare-All Plans | $54 | 186% |
| UnitedHealthcare | $60 - $64 | 206% |
| Multiplan-Phcs-All Plans | $61 | 210% |
| Federated Mutual Ins-All Plans | $61 | 210% |
| Cigna | $61 | 210% |
| Humana | $61 | 210% |
| Century/Wppa/Providers-All Plans | $61 | 210% |
| Blue Cross Blue Shield | $64 | 220% |
| Medicaid / KanCare | $64 | 220% |
Consumer Guidance & Cost Commentary
For the CPT code 97116 (Physical therapy, gait training) at Great Plains of Sabetha, the cash median price is $64.00, which matches the facility's negotiated rate for most payers. While the facility's cash price is significantly higher than the Medicare benchmark of $29.06, it is notably lower than the median negotiated rates paid by major insurers like UnitedHealthcare ($60–$64) and Blue Cross Blue Shield ($64). Patients with high-deductible plans may find paying the full cash price of $64.00 more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash rate, leaving the patient responsible for the difference after their deductible is met.
To minimize unexpected costs, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payments can bypass administrative fees and reduce the final bill. If a patient receives a bill that includes charges for services not rendered or unbundled components, they should request a formal itemized audit to identify errors, as over 80% of hospital bills contain such discrepancies. Additionally, under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, meaning any surprise charges should be disputed immediately with the insurer rather than paid out of pocket.