Physical therapy (gait training)
Facility: Greenwood County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $46
- Cash Discount Price: $44
- vs. Medicare Baseline: 1.58x 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 |
|---|---|---|
| Triwest - All Plans | $20 | 69% |
| UnitedHealthcare | $23 - $46 | 79% |
| Choicecare Mcr Adv - All Plans | $23 | 79% |
| Tricare | $23 | 79% |
| Integrated Health Plan - All Plans | $41 | 141% |
| Blue Cross Blue Shield | $44 - $46 | 151% |
| First Health Ccn Network | $47 | 162% |
| Beech Street - All Plans | $47 | 162% |
| First Health - All Other Plans | $47 | 162% |
| Preferred Hs (Coventry) - All Plans | $50 | 172% |
| Principal Health Care Inc - All Plans | $52 | 179% |
| Medicaid / KanCare | $55 | 189% |
| Amerigroup Mcaid-All Plans | $55 | 189% |
| Providrs Care/Wppa - All Plans | $82 | 282% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Greenwood County Hospital in Eureka, Kansas, lists a cash median price of $44.00 and a median negotiated rate of $46.00. This cash price is notably lower than the facility's gross charge of $55.00, offering potential savings for patients who pay directly. While the facility is a Critical Access Hospital with government local ownership, the data does not provide specific state or county average figures for this procedure, so direct comparisons to regional pricing benchmarks are not available in this report. Patients should note that while cash payment may appear cheaper, commercial insurance plans often negotiate rates that can exceed cash prices; however, in this specific case, the cash rate is already the lowest available option among the listed payers, ranging from $20 for Triwest to $82 for Providrs Care/Wppa.
The Medicare benchmark for this service is $29.06, which serves as a baseline for evaluating the facility's pricing structure. The cash price of $44.00 represents approximately 1.6 times the Medicare amount, while the negotiated rate of $46.00 is slightly higher. Given that the cash price is lower than the negotiated rates for most commercial payers, patients with high-deductible plans or those without insurance coverage may find the cash option most economical. To maximize savings, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these programs can offer additional reductions for upfront payments. It is also important to request an itemized bill to ensure all charges are accurate and to avoid paying for services that were not