Physical therapy (gait training)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $64
- Cash Discount Price: $68
- 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 |
|---|---|---|
| Humana | $39 | 134% |
| Tricare | $42 | 145% |
| UnitedHealthcare | $50 - $80 | 172% |
| Aetna | $50 - $72 | 172% |
| Va Ccn - All Plans | $50 | 172% |
| Medicaid / KanCare | $50 - $80 | 172% |
| Ambetter / Centene | $55 | 189% |
| Blue Cross Blue Shield | $64 | 220% |
| Health Partners - All Plans | $76 | 262% |
| Healthy Blue Mcaid - All Plans | $80 | 275% |
Consumer Guidance & Cost Commentary
For CPT code 97116, Physical therapy (gait training), Trego County Lemke Memorial Hospital in Wakeeney, KS, has a gross charge of $80.00. The facility's cash median price is $68.00, which is lower than the negotiated rates paid by most major payers, ranging from $50.00 to $80.00. While the median negotiated rate across payers is $64.00, patients with high-deductible plans may find paying the cash price of $68.00 upfront more cost-effective than relying on insurance, as the insurer's allowed amount could exceed the cash rate. It is important to note that the facility is a Critical Access Hospital owned by the Government - Local, and while the data does not provide a specific county or state average for comparison, the cash rate remains a strong baseline for self-pay patients.
Patients should be aware that this facility offers a prompt-pay discount, which can reduce the bill by 20% to 50% if paid in full within a short window, bypassing the administrative costs associated with insurance claims. To secure this discount, patients must request self-pay classification and a waiver of insurance submission before check-in to prevent automatic claims processing. Additionally, under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, though they should still request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final invoice.