Physical therapy (gait training)
Facility: Phillips County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $58
- Cash Discount Price: $54
- vs. Medicare Baseline: 2.00x 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.
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 - $52 | 158% |
| UnitedHealthcare | $51 - $64 | 175% |
| Health Partners-All Plans | $64 | 220% |
| Medicaid / KanCare | $64 | 220% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Phillips County Hospital in Phillipsburg, Kansas, the cash median price is $54.00, while the facility's negotiated rates range from $46.00 to $64.00 depending on the payer. This cash price is notably lower than the state average, which is $58.00, and aligns closely with the median negotiated rate of $52.00. Because commercial insurance contracts often include administrative overheads that inflate the baseline price by 20% to 40%, patients with high-deductible plans may find paying the cash price of $54.00 more cost-effective than relying on insurance, especially if the negotiated rate exceeds the cash amount.
When reviewing your final invoice, it is critical to request an itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, you should verify if the facility offers a prompt-pay discount, which can reduce the total cost by 20% to 50% if paid in full upfront, bypassing the costly claims processing cycle. Finally, compare the facility's pricing against the Medicare benchmark of $29.06; while the commercial negotiated rates average 200% to 300% of this federal rate, fair pricing is typically defined as 120% to 150%, providing a clear objective baseline to evaluate the facility's markup.