Physical therapy (gait training)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $70
- Cash Discount Price: $62
- vs. Medicare Baseline: 2.41x 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 241% of the Medicare baseline (a markup of 141%). 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% |
| UnitedHealthcare | $70 - $78 | 241% |
| Providers Care (Wppa)-All Plans | $136 | 468% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, the facility's cash median rate is $62.00, which is lower than the negotiated rates paid by major payers like UnitedHealthcare ($70.00) and Providers Care ($136.00). This pricing structure highlights a common billing dynamic where cash payments can be more cost-effective than insurance claims, particularly for patients with high deductibles or those who have already met their out-of-pocket maximum. While the facility is a Critical Access Hospital in Anthony, KS, and is owned by the Government Hospital District, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce the final cost.
The Medicare benchmark for this service is $29.06, which serves as a critical baseline for evaluating the facility's pricing markup. The cash rate of $62.00 represents approximately 212% of the Medicare amount, while the median negotiated rate of $70.00 reflects the administrative overhead and contract dynamics typical of commercial insurance. To ensure transparency and avoid unexpected costs, patients should request an itemized bill to review specific CPT codes and unit charges, rather than accepting a summary invoice that may obscure unbundled services or charges for items not rendered. If a balance bill arises from an out-of-network ancillary service, patients have the right to dispute the amount under the No Surprises Act, which prohibits providers from billing for the difference between the allowed amount and the chargemaster rate for emergency and non-emergency care at in-network facilities.