Physical therapy (gait training)
Facility: Scott County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $101
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.48x 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 348% of the Medicare baseline (a markup of 248%). 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 | $24 - $106 | 83% |
| Blue Cross Blue Shield | $46 | 158% |
| Humana | $47 | 162% |
| Wppa | $67 - $1,200 | 231% |
| Aetna | $101 | 348% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Scott County Hospital in Scott City, KS, the facility's negotiated rates range from $24 to $1200 across five payers, with a median negotiated amount of $101. This commercial rate is significantly higher than the Medicare benchmark of $29.06, reflecting a markup of 3.5 times the federal baseline. While commercial insurance contracts often include administrative overhead that inflates prices by 20% to 40%, patients should be aware that cash-pay options can sometimes result in lower out-of-pocket costs if their insurance deductible has not yet been met. Since the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, it is advisable to contact the billing department directly to inquire about self-pay or prompt-pay discounts, which can bypass the higher administrative costs associated with insurance processing.
The data indicates that while specific cash and median paid values are not currently available for this service, the wide variance in payer rates—from a low of $24 with UnitedHealthcare to a high of $1200 with Wppa—highlights the importance of verifying your specific plan's allowed amount before scheduling. Under the No Surprises Act, patients are protected from balance billing for out-of-network providers at in-network facilities, though unexpected charges can still occur for ancillary services like emergency care or specific lab tests. To ensure accuracy and avoid errors, patients should request a full itemized bill listing every CPT code and unit cost, as over 80% of hospital bills contain discrepancies such as unbundled charges or services not rendered. Disputing any inaccuracies should be done in