Physical therapy (gait training)
Facility: Osborne County Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $74
- Cash Discount Price: $69
- vs. Medicare Baseline: 2.55x 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 255% of the Medicare baseline (a markup of 155%). 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 |
|---|---|---|
| UnitedHealthcare | $62 | 213% |
| Health Partners Of Kansas | $70 | 241% |
| Wppa | $77 | 265% |
| Blue Cross Blue Shield | $79 | 272% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, the gross charge at Osborne County Memorial Hospital is $81.00. This facility is a Critical Access Hospital in Osborne, Kansas, and its negotiated rates range from $62.00 to $79.00 depending on the payer, with UnitedHealthcare, Health Partners Of Kansas, Wppa, and Blue Cross Blue Shield each having a single plan at these specific amounts. The cash median price is $69.00, which is notably lower than the negotiated rates for most commercial payers listed. When compared to the Medicare benchmark of $29.06, the facility's gross charge is 2.5 times higher, illustrating the typical markup found in commercial billing structures.
Patients should be aware that while in-network insurance prevents balance billing, the negotiated rate paid by the insurer may exceed the cash price, making self-pay a potentially more affordable option for those with high deductibles. Since the cash median ($69.00) is lower than the lowest negotiated rate ($62.00) for some payers but higher than the lowest negotiated rate for others, it is crucial to verify your specific plan's allowed amount before scheduling. To maximize savings, you should contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid upfront. Additionally, because over 80% of hospital bills contain errors, requesting a detailed itemized statement before payment is essential to ensure no unbundled codes or services not rendered are included in the final charge.