Physical therapy (gait training)
Facility: Girard Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $39
- Cash Discount Price: $66
- vs. Medicare Baseline: 1.34x 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.
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 |
|---|---|---|
| Medicare (plans) | $38 | 131% |
| Ambetter / Centene | $38 | 131% |
| Kansas Superior Select-All Plans | $38 | 131% |
| Aetna | $38 - $192 | 131% |
| UnitedHealthcare | $38 - $104 | 131% |
| Humana | $38 | 131% |
| Blue Cross Blue Shield | $38 - $46 | 131% |
| Multiplan-All Plans | $102 | 351% |
| Uhhis-All Plans | $104 | 358% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Girard Medical Center in Kansas, the facility's cash median rate is $66.00, while the median negotiated rate across insurance plans is $39.00. This facility, a Critical Access Hospital in Girard (ZIP 66743), operates under a government hospital district authority. The data indicates that for this specific service, the cash price is significantly higher than the negotiated rates paid by insurers such as Aetna, UnitedHealthcare, and Humana. While commercial insurance contracts generally cap payments below the full chargemaster, the cash price here exceeds the negotiated amount, suggesting that patients with high-deductible plans or those seeking immediate payment might find the cash rate less favorable than the insurance allowed amount, provided their deductible is met.
When evaluating the cost relative to the national standard, the facility's cash rate is 1.3 times the Medicare benchmark of $29.06, which serves as the objective baseline for healthcare delivery costs. Although the data does not provide explicit state or county average comparisons for this specific code, the facility's location in a rural Critical Access Hospital setting often influences pricing dynamics compared to urban centers. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it does not automatically guarantee the lowest possible price. To optimize costs, consumers are encouraged to verify their specific plan's negotiated rates before scheduling and to inquire directly with the billing department about "self-pay" or "prompt-pay" discounts, which can offer further reductions if the patient pays in full upfront.