Physical therapy (gait training)
Facility: Cloud County Health Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $90
- Cash Discount Price: $66
- 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 |
|---|---|---|
| Aetna | $85 - $88 | 292% |
| Mpi-All Plans | $90 | 310% |
| Pponext-All Plans | $90 | 310% |
| Health Partners - All Plans | $90 | 310% |
Consumer Guidance & Cost Commentary
For the Physical therapy (gait training) service at Cloud County Health Center in Concordia, KS, the negotiated rates across four insurance plans range from $85 to $90, which aligns with the facility's median negotiated amount of $90.00. While the facility's cash price is $66.00, which is lower than the insurance negotiated rates, patients with high-deductible plans may find paying out-of-pocket initially more cost-effective if their insurance allows a higher allowed amount than the cash price. It is important to note that the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, and patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling to ensure they are not billed the full negotiated rate.
The billing process for this service involves a gross charge of $94.00, but commercial payers negotiate this down to the $85–$90 range, whereas Medicare reimburses at a fixed rate of $29.06. Because commercial negotiated rates often exceed the Medicare benchmark, patients should verify their deductible status before relying on insurance, as they may still be responsible for the difference between their deductible and the allowed amount. To avoid unexpected costs, consumers should request an itemized bill to review specific CPT codes and ensure no unbundled charges or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute.