Physical therapy (gait training)
Facility: Goodland Regional Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $67
- Cash Discount Price: $67
- vs. Medicare Baseline: 2.31x 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 231% of the Medicare baseline (a markup of 131%). 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% |
| Wppa | $63 - $67 | 217% |
| UnitedHealthcare | $67 | 231% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Goodland Regional Medical Center lists a cash median price of $67.00, which is lower than the facility's gross charge of $74.00. While the facility is a Critical Access Hospital in Goodland, Kansas, the data does not provide specific county or state average rates for this procedure, so a direct comparison to regional pricing benchmarks is not available. Patients should note that the cash price of $67.00 is also identical to the facility's median negotiated rate, suggesting that paying out-of-pocket may be the most cost-effective option for those without insurance or with high-deductible plans where the insurance allowed amount could exceed the cash price.
Insurance coverage for this service varies by payer, with Blue Cross Blue Shield showing a single plan at $46.00, WPPA plans ranging from $63.00 to $67.00, and UnitedHealthcare plans at $67.00. It is important to understand that commercial negotiated rates often include administrative overhead and may not reflect the true cost of care, which is better represented by the Medicare amount of $29.06. To minimize costs, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can sometimes bypass the higher administrative costs associated with insurance billing cycles. Additionally, if you receive a bill, always request a detailed itemized statement to verify that no services were unbundled or incorrectly charged, as over 80% of hospital bills contain errors that can be corrected through a formal audit.