Physical therapy (gait training)
Facility: Amberwell Atchison Association
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $94
- Cash Discount Price: $180
- vs. Medicare Baseline: 3.23x 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 323% of the Medicare baseline (a markup of 223%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $44 - $46 | 151% |
| Triwest - All Plans | $56 - $63 | 193% |
| Superior Select Mcr Adv - All Plans | $56 - $63 | 193% |
| Humana | $56 - $86 | 193% |
| UnitedHealthcare | $56 - $341 | 193% |
| Va Ccn - All Plans | $56 - $63 | 193% |
| Ambetter / Centene | $87 - $97 | 299% |
| Aetna | $94 - $104 | 323% |
| Cigna | $94 - $104 | 323% |
| Oscar - All Plans | $128 - $142 | 440% |
| Centrus Health Direct - All Plans | $128 - $142 | 440% |
| Multiplan - All Plans | $133 - $148 | 458% |
| Wppa Providrs Care - All Plans | $153 - $171 | 526% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy (gait training), the cash price at Amberwell Atchison Association is $180.00, which matches the facility's median cash rate. This cash price is significantly higher than the national average for this service, which is approximately $90.00. While commercial insurance plans like UnitedHealthcare and Humana negotiate rates as high as $341.00 and $86.00 respectively, these negotiated amounts often exceed the cash price. Patients with high-deductible plans may find paying the $180.00 cash price directly more cost-effective than relying on insurance, as the insurer's allowed amount could be substantially higher than the cash rate. To secure the lowest possible price, patients should explicitly ask the facility about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill.
The facility's pricing is evaluated against the Medicare benchmark, which stands at $29.06 for this procedure. The cash price of $180.00 represents a markup of 3.2 times the Medicare rate, indicating a significant difference between the federal cost baseline and the commercial pricing structure. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still review their itemized bills carefully. Over 80% of hospital bills contain errors, such as unbundled codes or services not rendered, so requesting a detailed, line-by-line audit before paying is a critical step to ensure accuracy. Additionally, patients should verify their deductible status, as paying the full