Physical therapy (gait training)
Facility: Republic County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $70
- Cash Discount Price: $57
- vs. Medicare Baseline: 2.41x 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 241% of the Medicare baseline (a markup of 141%). 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 |
|---|---|---|
| Rural Carriers-All Plans | $65 | 224% |
| Meritain-All Plans | $68 | 234% |
| Aetna | $68 | 234% |
| UnitedHealthcare | $70 | 241% |
| Cigna | $72 | 248% |
| First Health-All Plans | $72 | 248% |
| Midlands Choice-All Plans | $72 | 248% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Republic County Hospital in Belleville, Kansas, lists a cash median price of $57.00 and a median negotiated rate of $70.00. This cash price is notably lower than the facility's Medicare benchmark of $29.06, which serves as the federal baseline for the true cost of care. While the negotiated rate of $70.00 is higher than the cash option, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $57.00, as paying the lower cash rate could result in immediate savings compared to the administrative overhead and potential deductibles associated with insurance claims.
The facility, a voluntary non-profit Critical Access Hospital, reports a facility rating of 3 and is located in ZIP code 66935. Patients should be aware that while the hospital offers a cash median of $57.00, the actual self-pay or prompt-pay discount may be lower if requested directly at registration before check-in. It is crucial to avoid accepting summary bills that obscure individual charges; instead, consumers should request a full itemized CPT-coded statement to verify that no unbundled codes or services not rendered are included. By comparing the facility's specific rates against the Medicare benchmark and actively seeking prompt-pay discounts, patients can ensure they are paying a fair, transparent price that aligns with the actual cost of delivery rather than inflated chargemaster lists.