Physical therapy (gait training)
Facility: Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $52
- Cash Discount Price: $94
- vs. Medicare Baseline: 1.79x 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 |
|---|---|---|
| Tricare | $47 | 162% |
| Humana | $47 | 162% |
| Medicare (plans) | $48 | 165% |
| Blue Cross Blue Shield | $49 | 169% |
| Ambetter / Centene | $52 | 179% |
| Coventry - All Other Plans | $85 | 292% |
| Health Partners Of Kansas - All Plans | $90 | 310% |
| Preferred Healthcare-All Plans | $90 | 310% |
| Wppa/Providers Care-All Plans | $132 | 454% |
Consumer Guidance & Cost Commentary
For this physical therapy service in Abilene, KS, the cash price of $94.00 is significantly higher than the median negotiated rate of $52.00 paid by insurance plans. While the facility is a Critical Access Hospital with a government ownership structure, patients should be aware that commercial insurance rates often include administrative overhead and contractual ceilings that can exceed the direct cash price. In this specific case, paying out-of-pocket for $94.00 is more expensive than the average negotiated rate of $52.00, which aligns with the state average for this procedure. However, if a patient has a high-deductible plan that has not yet met their out-of-pocket maximum, the $52.00 negotiated rate may still result in a higher total cost than the $94.00 cash price, depending on their specific deductible status and the amount the insurer allows.
To minimize costs, patients should verify whether the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these programs can reduce the final bill by 20% to 50% for upfront payments. It is also important to request an itemized billing audit if a summary bill is received, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can inflate the total. Finally, while the Medicare benchmark for this service is $29.06, commercial rates are often marked up significantly above this federal baseline; comparing the $52.00 negotiated rate to the Medicare amount provides a clearer picture of the facility's pricing markup than comparing it to the inflated chargemaster gross of $94.00.