Physical therapy (gait training)
Facility: Wilson Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $90
- Cash Discount Price: $85
- vs. Medicare Baseline: 3.10x 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 310% of the Medicare baseline (a markup of 210%). 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 | $46 - $113 | 158% |
| Tricare | $60 | 206% |
| Aetna | $60 - $113 | 206% |
| UnitedHealthcare | $60 - $105 | 206% |
| Ambetter / Centene | $60 - $113 | 206% |
| Humana | $60 | 206% |
| Cigna | $90 | 310% |
| Mulitplan-All Plans | $104 | 358% |
| Health Partners-All Plans | $104 | 358% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Wilson Medical Center in Neodesha, KS, the facility's cash median rate is $85.00, which is lower than the negotiated rates paid by most major insurers. While the facility's negotiated average is $90.00, commercial payers like Blue Cross Blue Shield, Aetna, and UnitedHealthcare have allowed amounts ranging from $60 to $113, meaning patients with high-deductible plans might save money by paying the cash price directly. It is important to note that commercial rates often exceed cash prices due to administrative overhead and contract structures, so patients should explicitly ask the hospital for "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not charged the full negotiated amount.
The facility's pricing is also significantly higher than the Medicare benchmark, with the Medicare amount set at $29.06. This highlights that commercial rates can be several times the true cost baseline established by federal reimbursement standards. Additionally, while the facility is a Critical Access Hospital owned by the local government, patients should remain vigilant regarding balance billing if they receive care from out-of-network providers, as federal protections under the No Surprises Act may prevent unexpected charges for emergency services. To avoid errors, consumers should request a full itemized bill before paying, ensuring no unbundled codes or services not rendered are included in the final invoice.