Physical therapy (gait training)
Facility: Fredonia Regional Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $59
- Cash Discount Price: $66
- vs. Medicare Baseline: 2.03x 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 203% of the Medicare baseline (a markup of 103%). 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 | $32 - $46 | 110% |
| UnitedHealthcare | $33 - $217 | 114% |
| Aetna | $33 - $59 | 114% |
| Veterans Programs - All Plans | $33 | 114% |
| Cigna | $59 | 203% |
| Meritain-All Plans | $59 | 203% |
| Reserve National-All Plans | $59 | 203% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Fredonia Regional Hospital in Kansas, the cash price is $66.00, which matches the facility's median negotiated rate of $59.00. While the hospital's gross charge is $66.00, the Medicare benchmark for this service is $29.06, indicating that the cash price is more than double the federal baseline. It is important to note that commercial insurance plans, such as Blue Cross Blue Shield and UnitedHealthcare, have negotiated rates ranging from $32.00 to $217.00 depending on the specific plan, which can sometimes exceed the cash price. Patients with high-deductible plans may find it financially advantageous to pay the $66.00 cash rate directly, as this avoids potential deductibles and copays associated with the higher commercial negotiated rates.
To maximize savings, patients should actively inquire about self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, since this facility is a Critical Access Hospital with government local ownership, verifying the specific allowed amount for your insurance plan is crucial, as in-network rates vary significantly across the seven payers listed. If you receive a bill that includes charges for services not rendered or unbundled components, you should request a full itemized audit to identify errors, as over 80% of hospital bills contain discrepancies. Always compare the final out-of-pocket cost against the Medicare benchmark of $29.06 to ensure you are not being overcharged relative to the true cost of care.