Physical therapy (gait training)
Facility: Hiawatha Community Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $144
- Cash Discount Price: $180
- vs. Medicare Baseline: 4.96x 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 496% of the Medicare baseline (a markup of 396%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $44 - $46 | 151% |
| Aetna | $63 - $154 | 217% |
| UnitedHealthcare | $63 - $163 | 217% |
| Humana | $64 - $71 | 220% |
| Ambetter / Centene | $75 - $84 | 258% |
| Centrus Health Direct - All Plans | $128 - $142 | 440% |
| Oscar - All Plans | $128 - $142 | 440% |
| Preferred Hlth - All Plans | $153 - $171 | 526% |
| Cigna | $162 - $180 | 557% |
| Wppa Providrs Care - All Plans | $162 - $180 | 557% |
| Multiplan - All Plans | $165 - $184 | 568% |
| Midlands Choice - All Plans | $165 - $184 | 568% |
| Healthy Blue Mcaid - All Plans | $170 - $190 | 585% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy (gait training), Hiawatha Community Hospital in Hiawatha, KS, lists a cash price of $180.00. This cash rate matches the facility's maximum negotiated rate with Cigna and WPPA Providers Care, and it is identical to the cash median for this service in the region. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that commercial insurance negotiated rates for this service range widely, from $44 to $190 depending on the payer. For instance, Blue Cross Blue Shield plans pay a maximum of $46, whereas Preferred Hlth - All Plans pay up to $171. Because commercial negotiated rates often exceed cash prices due to administrative overhead and contract dynamics, patients with high-deductible plans or those without insurance may find paying the $180 cash price more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the deductible is not yet met.
The facility's cash price is significantly higher than the Medicare benchmark of $29.06, reflecting a markup typical of commercial pricing structures where rates can average 200% to 300% of the Medicare amount. However, the median amount actually paid by insurers for this service is $143.00, which is lower than the cash price and aligns closely with the facility's median negotiated rate of $144.00. Given that over 80% of hospital bills contain errors, patients should request an itemized billing audit to verify that charges for gait training are accurate and that no unb