Physical therapy (gait training)
Facility: William Newton Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $47
- Cash Discount Price: $130
- vs. Medicare Baseline: 1.62x 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 | $44 - $47 | 151% |
| Triwest- All Plans | $45 | 155% |
| UnitedHealthcare | $47 - $117 | 162% |
| Ambetter / Centene | $47 - $130 | 162% |
| Providrs Care Nexus | $80 | 275% |
| Providrs Care - All Other Plans | $91 | 313% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at William Newton Hospital in Winfield, KS, the cash price is $130.00, which matches the facility's gross charge and the median cash rate. This cash price is significantly higher than the Medicare benchmark of $29.06, a standard used to evaluate pricing markups, and exceeds the median negotiated rate of $47.00 paid by most insurers. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should note that commercial payers like UnitedHealthcare and Ambetter / Centene have negotiated ranges extending up to $130, meaning the cash price may not always be the lowest option. However, for individuals with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price of $130.00 upfront could result in lower total costs compared to insurance claims where the negotiated rate exceeds the cash amount.
Before scheduling, it is crucial to verify your specific plan's allowed amount, as the data shows a wide variation among payers, with Triwest- All Plans negotiating a fixed rate of $45.00 while UnitedHealthcare's range spans from $47.00 to $117.00. If you choose to pay out-of-pocket, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees. Additionally, since the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, ensure you