Physical therapy (gait training)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $40
- Cash Discount Price: $58
- vs. Medicare Baseline: 1.38x 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 |
|---|---|---|
| Aetna | $27 - $46 | 93% |
| UnitedHealthcare | $33 | 114% |
| Blue Cross Blue Shield | $46 | 158% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Community Memorial Healthcare, Inc. in Marysville, KS, lists a cash median price of $58.00, which matches the facility's negotiated median of $40.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the data provided does not include specific state or county average figures for this procedure, so a direct comparison to regional pricing benchmarks cannot be made. Patients should note that the cash price of $58.00 is identical to the Medicare amount of $29.06 multiplied by a factor of 1.4, indicating the cash rate is 40% higher than the Medicare benchmark. For individuals with high-deductible plans, paying the cash price directly might be more cost-effective than using insurance, as the negotiated rate of $40.00 could still exceed the out-of-pocket maximum or deductible threshold depending on the specific plan.
Insurance coverage for this service varies significantly across payers, with allowed amounts ranging from $27 to $46 depending on the plan. Aetna plans show a range of $27 to $46, UnitedHealthcare allows $33, and Blue Cross Blue Shield allows $46. The facility's facility rating is 4, and the billing data is based on the 2026-06 vintage. Consumers should be aware that while the facility offers a cash price of $58.00, they must explicitly request a "self-pay" or "prompt-pay" discount before scheduling to ensure they receive the lowest possible rate. It is also important to demand an item