Physical therapy (gait training)
Facility: Lincoln County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $46
- Cash Discount Price: $73
- vs. Medicare Baseline: 1.58x 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 | 158% |
Consumer Guidance & Cost Commentary
For this Physical therapy (gait training) service at Lincoln County Hospital in Lincoln, KS, the cash price of $73.00 is notably lower than the facility's negotiated rate of $46.00, which represents the amount Blue Cross Blue Shield pays. While the cash price is lower than the negotiated rate, it is still significantly higher than the Medicare benchmark of $29.06, indicating a markup of 160% over the federal baseline. This pricing structure highlights that for patients with high-deductible plans, paying cash upfront might be more cost-effective than relying on insurance, as the negotiated rate often exceeds the cash price. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative fees and claims processing costs.
It is important to note that this facility is a Critical Access Hospital with government-local ownership, and the data reflects a single payer plan for the 2026-06 vintage. The gross chargemaster rate listed is $81.00, but the actual cost to the patient depends on whether they utilize insurance or pay directly. If you have insurance, be aware that while the facility is in-network with Blue Cross Blue Shield, the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities, though you should still verify that all ancillary services, such as specific lab tests or emergency physician visits, are covered under your plan. To ensure you are not overcharged, always request a full itemized bill before paying, as summary invoices may hide unbundled codes or services not rendered, and dispute any errors in writing to protect your rights.