Physical therapy (gait training)
Facility: Mitchell County Hospital Health Systems
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $75
- Cash Discount Price: $71
- vs. Medicare Baseline: 2.58x 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 258% of the Medicare baseline (a markup of 158%). 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 | $28 - $79 | 96% |
| Blue Cross Blue Shield | $46 | 158% |
| Triwest Well Mark All Plans | $67 | 231% |
| Aetna | $71 | 244% |
| First Health-All Plans | $71 | 244% |
| Pref Hlth Care Sytms Comm - All Plans | $71 | 244% |
| Multiplan Ppo - All Plans | $75 | 258% |
| Phc Leased Ntwrk Access - All Plans | $75 | 258% |
| Auxiant-All Plans | $75 | 258% |
| Health Partners Ks-All Plans | $78 | 268% |
| Cigna | $78 | 268% |
Consumer Guidance & Cost Commentary
For CPT code 97116, Physical therapy (gait training), the gross charge at Mitchell County Hospital Health Systems is $79.00. While the facility's cash median rate is $71.00, which is lower than the gross charge, the negotiated rates for in-network payers range from $28 to $79. Notably, the lowest negotiated rate of $28 from UnitedHealthcare is significantly lower than the facility's cash price, meaning patients with high-deductible plans or those who have met their deductible may save money by using insurance rather than paying cash. However, patients should verify their specific plan's allowed amount, as some commercial payers have negotiated rates that exceed the cash price. It is also important to check with the hospital directly for potential "self-pay" or "prompt-pay" discounts, which can further reduce the final bill for those choosing to pay out-of-pocket.
The facility's pricing is benchmarked against federal standards, with a Medicare amount of $29.06. The commercial negotiated rates observed in this dataset generally align with or exceed the cash rate, reflecting the administrative costs and contract dynamics inherent in insurance billing. Because the facility is a Critical Access Hospital in Beloit, KS, and is government-owned, patients should be aware that balance billing is restricted for in-network services under the No Surprises Act, but unexpected charges can still occur if ancillary services are out-of-network. To ensure accuracy, patients should request a full itemized bill before paying, as summary bills may obscure individual line items. If a patient receives a bill that seems incorrect, they should dispute it in writing rather than accepting a verbal settlement, as over 8