Physical therapy (gait training)
Facility: Stanton County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $100
- Cash Discount Price: $105
- vs. Medicare Baseline: 3.44x 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 344% of the Medicare baseline (a markup of 244%). 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 - $100 | 151% |
| Healthy Blue Mcr Adv - All Other Plans | $103 | 354% |
| Healthy Blue Mcaid | $105 | 361% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Stanton County Hospital in Johnson, KS, the cash price is $105.00, which matches the facility's negotiated rate. This cash price is significantly lower than the state average for this service, which is $101.00, and notably higher than the Medicare benchmark of $29.06. While the facility is a Critical Access Hospital with government local ownership, patients should be aware that paying cash upfront may offer a financial advantage if their insurance plan has a high deductible, as the negotiated rate of $105.00 exceeds the cash price. To maximize savings, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the total cost by bypassing administrative claim processing fees.
The data indicates that three payers have negotiated rates for this procedure, with Blue Cross Blue Shield ranging from $44.00 to $100.00 across three plans, while other Healthy Blue plans maintain a fixed rate of $105.00. Although the median negotiated amount is $100.00, the presence of a wide range in Blue Cross Blue Shield rates suggests that specific plan details will determine the final out-of-pocket cost. Given that over 80% of hospital bills often contain errors, patients should request a detailed, itemized statement before paying to verify that all charges align with the service rendered and to identify any unbundled codes or services not received. By comparing these specific facility rates against the Medicare benchmark and seeking prompt-pay options, consumers can make informed