Physical therapy (gait training)
Facility: Hodgeman County Health Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $73
- Cash Discount Price: $83
- vs. Medicare Baseline: 2.51x 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 251% of the Medicare baseline (a markup of 151%). 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 | $44 - $46 | 151% |
| Medicaid / KanCare | $67 - $104 | 231% |
| Humana | $67 | 231% |
| UnitedHealthcare | $67 - $99 | 231% |
| Triwest - All Plans | $67 | 231% |
| Aetna | $83 | 286% |
| First Health - All Plans | $94 | 323% |
| Wppa (Provdrscare) - All Plans | $99 | 341% |
| Health Partners - All Plans | $99 | 341% |
Consumer Guidance & Cost Commentary
For the Physical therapy (gait training) service at Hodgeman County Health Center in Jetmore, Kansas, the cash median price is $83.00, which is lower than the negotiated rates paid by most major insurers. While the facility's cash rate aligns with the lowest end of the insurance spectrum, several payers, including Blue Cross Blue Shield, Medicaid/KanCare, and UnitedHealthcare, negotiate rates ranging from $67 to $104. Because cash-pay can sometimes be cheaper for patients with high-deductible plans, it is often advisable to ask the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling. These upfront payment incentives can bypass the administrative costs and multi-layered pricing structures that typically inflate commercial insurance rates.
The facility's negotiated rates are significantly higher than the Medicare benchmark, which stands at $29.06 for this procedure. This disparity highlights that commercial rates often include substantial markups for administrative processing and network tiering, with some insurers paying up to 2.5 times the Medicare amount. To ensure you are not overpaying, it is recommended to request a full itemized billing audit if you receive a summary bill, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. Additionally, if you receive a balance bill from an out-of-network provider, you may be entitled to protections under the No Surprises Act, which bans surprise billing for emergency and non-emergency services at in-network facilities.