Physical therapy (gait training)
Facility: Minneola District Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $66
- Cash Discount Price: $51
- vs. Medicare Baseline: 2.27x 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 227% of the Medicare baseline (a markup of 127%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $46 | 158% |
| Va Community Care Program-All Plans | $49 | 169% |
| UnitedHealthcare | $49 - $73 | 169% |
| Humana | $49 | 169% |
| Providrs Care Network-All Plans | $62 | 213% |
| Corporate Plan Management-All Plans | $62 | 213% |
| Triwest-All Plans | $66 | 227% |
| Preferred Health Care (Coventry)-All Other Plans | $66 | 227% |
| Phc (Coventry) Leased Network | $69 | 237% |
| Health Partners Of Kansas-All Plans | $69 | 237% |
| Aetna | $69 - $73 | 237% |
| Medicaid / KanCare | $73 | 251% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Minneola District Hospital, the facility's cash median rate is $51.00, which is lower than the negotiated rates paid by most insurance plans. While the facility's cash price is significantly below the gross charge of $73.00, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative costs and contract structures. For instance, UnitedHealthcare and Aetna have negotiated ranges reaching up to $73.00, meaning patients with high-deductible plans might save money by paying the cash rate of $51.00 directly, provided they do not have other covered services that would trigger insurance billing.
The facility's negotiated rate of $66.00 aligns with the median paid amount across all payers, though it remains higher than the Medicare benchmark of $29.06. This indicates a markup of approximately 127% relative to the federal baseline, which falls within the typical range for commercial pricing. To minimize costs, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can bypass the standard insurance billing cycle and reduce the final bill. Additionally, if any unexpected charges arise, consumers should request a full itemized audit to verify that no unbundled codes or services not rendered have been included in the final invoice.