Physical therapy (gait training)
Facility: Kingman Healthcare Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $136
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 4.68x 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 468% of the Medicare baseline (a markup of 368%). 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 |
|---|---|---|
| Humana | $136 | 468% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Kingman Healthcare Center in Kingman, KS, the facility's negotiated rate is $136.00. This amount aligns exactly with the lowest and highest reported values for Humana, the single payer in this dataset. While the facility is a Critical Access Hospital with voluntary non-profit ownership, the data does not provide a specific cash-pay or median paid amount for this service. In cases where a patient has a high deductible plan, paying cash directly can sometimes be more cost-effective than using insurance, as the negotiated rate of $136.00 may exceed the actual cash price offered by the hospital. Patients are encouraged to contact the facility directly to inquire about self-pay or prompt-pay discounts, which can significantly reduce the final bill.
The Medicare benchmark for this procedure is $29.06, which serves as a baseline for evaluating the facility's pricing markup. Although the data does not include specific state or county average rates for comparison, the significant difference between the Medicare amount and the negotiated rate highlights the administrative costs and contract dynamics inherent in commercial insurance billing. To avoid unexpected costs, patients should request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes. If a balance bill arises from an out-of-network situation, patients should verify its legality under the No Surprises Act and dispute the charge in writing rather than paying immediately.