Physical therapy (gait training)
Facility: Sheridan County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $64
- Cash Discount Price: $93
- vs. Medicare Baseline: 2.20x 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 220% of the Medicare baseline (a markup of 120%). 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 |
|---|---|---|
| Celtic Insurance | $56 | 193% |
| Blue Cross Blue Shield | $64 | 220% |
| UnitedHealthcare | $88 | 303% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, Physical therapy (gait training), Sheridan County Hospital in Hoxie, KS, lists a cash median price of $93.00. This cash rate is significantly higher than the state average, which is $29.06, and exceeds the Medicare benchmark of $29.06 by a factor of 2.2. While the facility offers a median negotiated rate of $64.00 for in-network payers such as Celtic Insurance, Blue Cross Blue Shield, and UnitedHealthcare, this amount remains above the cash price. For patients with high-deductible plans or those who have already met their out-of-pocket maximum, paying the cash price of $93.00 directly may be more cost-effective than using insurance, as the negotiated rates can sometimes exceed the cash rate due to administrative overhead and contract structures.
To ensure you are receiving the most accurate pricing, it is crucial to request an itemized billing audit before finalizing payment, as summary bills often obscure individual line items and potential errors. Additionally, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by offering immediate liquidity incentives. Given that the facility is a Critical Access Hospital with government-local ownership, verifying the specific payment classification at the time of scheduling is essential to avoid automatic claims submission that could void any cash discounts. Always compare the final allowed amount against the Medicare rate to understand the true markup and ensure you are not overpaying for covered services.