Physical therapy (gait training)
Facility: Decatur Health
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $83
- Cash Discount Price: $92
- vs. Medicare Baseline: 2.86x 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 286% of the Medicare baseline (a markup of 186%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $57 - $66 | 196% |
| UnitedHealthcare | $58 - $83 | 200% |
| Humana | $58 - $67 | 200% |
| Blue Cross Blue Shield | $60 | 206% |
| Midlands Choice- All Plans | $85 - $98 | 292% |
| Aetna | $85 - $109 | 292% |
| Medicaid / KanCare | $95 - $110 | 327% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, Physical therapy (gait training), Decatur Health in Oberlin, KS, lists a cash median price of $92.00 and a median negotiated rate of $83.00. This cash price is notably lower than the facility's Medicare benchmark of $29.06, which serves as the federal baseline for cost. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance rates can vary significantly. For instance, UnitedHealthcare and Humana have negotiated ranges starting at $58, while Aetna and Midlands Choice range up to $109, illustrating that in-network rates are not uniform across all payers.
Patients should consider that paying cash upfront might result in a lower out-of-pocket cost than using insurance, especially if their plan has a high deductible or if the negotiated rate exceeds the cash price. It is advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the bill by bypassing administrative processing fees. Furthermore, if you receive an itemized bill, review it carefully to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute. Always verify your deductible status before scheduling, as paying the full negotiated rate without meeting your deductible can lead to unexpected financial exposure.