Physical therapy (gait training)
Facility: Morris County Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $55
- Cash Discount Price: $53
- vs. Medicare Baseline: 1.89x 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 |
|---|---|---|
| Blue Cross Blue Shield | $35 - $46 | 120% |
| Va Ccn-All Plans | $35 | 120% |
| Coventry Mcr | $35 | 120% |
| Choice Care Mcr Adv-All Plans | $35 | 120% |
| UnitedHealthcare | $35 - $89 | 120% |
| Cigna | $64 | 220% |
| Coventry Comm-All Other Plans | $80 | 275% |
| Multiplan-All Plans | $80 | 275% |
| Aetna | $80 | 275% |
| Providrs Care (Wppa)(Nexus)-All Plans | $134 | 461% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training, Morris County Hospital in Council Grove, KS, lists a gross charge of $89.00. While the facility's cash median is $53.00 and the median negotiated rate across payers is $55.00, the Medicare benchmark for this service is $29.06. This indicates that the commercial negotiated rates are approximately 1.9 times the Medicare amount, which is significantly higher than the typical fair pricing range of 120% to 150% of Medicare. Patients should be aware that while in-network insurance plans cap costs at the negotiated rate of $55.00, paying cash directly at $53.00 can sometimes result in lower out-of-pocket expenses, particularly for those with high-deductible plans who may not yet have met their coverage thresholds.
The facility, a Critical Access Hospital owned by the local government, reports a facility rating of 3 and is located in zip code 66846. Before scheduling any appointments, it is crucial to verify your specific insurance plan's allowed amount, as negotiated rates vary by carrier; for instance, UnitedHealthcare allows up to $89.00 while most other plans cap at $35.00 to $64.00. To minimize costs, patients should proactively ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. Additionally, if you receive a summary bill, request a full itemized statement to ensure no errors or unb