Physical therapy (gait training)
Facility: St Luke Hospital & Living Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $33
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.14x 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 |
|---|---|---|
| Kansas Department Of Health And Environment | $33 | 114% |
| Blue Cross Blue Shield | $33 | 114% |
| UnitedHealthcare | $33 | 114% |
| Humana | $33 | 114% |
| Bluestem Pace | $33 | 114% |
| Ambetter / Centene | $33 | 114% |
| Va Ccn | $33 | 114% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, St Luke Hospital & Living Center in Marion, KS, has a gross charge of $65.00. This amount is significantly higher than the state average, which is reflected in a Medicare benchmark ratio of 1.1 times the federal rate. The facility's negotiated rates for in-network payers, such as Blue Cross Blue Shield and UnitedHealthcare, are set at $33.00, which aligns with the state median negotiated amount. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should note that the cash price is not listed in this report. However, for individuals with high-deductible plans, paying cash upfront could potentially be more cost-effective if the negotiated insurance rate exceeds the cash price, though the cash median is currently unavailable for this service.
Patients should be aware that commercial insurance rates often include administrative costs and contract premiums that can inflate the final price compared to the true cost of care. The No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, but it is crucial to verify that the specific provider or ancillary services used during your visit are indeed in-network to avoid unexpected charges. Before scheduling your appointment, it is highly recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if you settle the bill in full within a short timeframe. Additionally, if you receive an itemized bill, request a full line-by-line audit to ensure no unbundled codes or services not rendered have been charged, as over