Physical therapy (gait training)
Facility: Neosho Memorial Regional Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $45
- Cash Discount Price: $106
- vs. Medicare Baseline: 1.55x 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 |
|---|---|---|
| Medicaid / KanCare | $24 | 83% |
| Tricare | $44 | 151% |
| Aetna | $45 | 155% |
| Medadv_Allwell | $45 | 155% |
| Humana | $45 | 155% |
| Blue Cross Blue Shield | $45 - $51 | 155% |
| Va_Ccn | $45 | 155% |
| Medadv_Uhc | $45 | 155% |
| Medicare (plans) | $45 | 155% |
| Ambetter / Centene | $71 | 244% |
| Wppa_Providrscare | $117 | 403% |
| United | $118 | 406% |
| Hpk | $134 | 461% |
| Cigna | $134 | 461% |
| Coventry | $134 | 461% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy and gait training, Neosho Memorial Regional Medical Center in Chanute, KS, lists a gross charge of $141.00. While the facility's cash median rate is $106.00 and the median negotiated rate across payers is $45.00, the Medicare benchmark for this service is significantly lower at $29.06. This indicates that the facility's negotiated rates are approximately 1.5 times the Medicare amount, which is higher than the typical fair pricing range of 120% to 150% of Medicare. Patients should be aware that while in-network insurance plans generally pay the lower negotiated rate of $45.00, this amount may still exceed the cash price of $106.00 if the patient has a high deductible or is paying out-of-pocket, making the cash rate potentially more cost-effective in those specific scenarios.
The facility, a Critical Access Hospital with government-local ownership, reports a facility rating of 1 and serves 15 different payers, with negotiated rates ranging from $24 for Medicaid/KanCare to $134 for providers like Hpk and Cigna. Because the facility is in-network for most major plans, patients are protected from balance billing for emergency and non-emergency services under the No Surprises Act, though they should verify that all ancillary services, such as specific lab tests or medications, are also in-network to avoid unexpected charges. To minimize costs, patients are encouraged to contact the billing department directly to confirm their specific plan's allowed amount and to inquire about self-pay or prompt-pay discounts,