Physical therapy (gait training)
Facility: Bob Wilson Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $82
- Cash Discount Price: $40
- vs. Medicare Baseline: 2.82x 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 282% of the Medicare baseline (a markup of 182%). 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 |
|---|---|---|
| UnitedHealthcare | $32 - $83 | 110% |
| Humana | $32 | 110% |
| Kansas Health | $32 | 110% |
| Aetna | $32 - $80 | 110% |
| Medicare (plans) | $32 | 110% |
| Blue Cross Blue Shield | $62 | 213% |
| Centura Employee Plan | $72 | 248% |
| Multiplan | $90 - $93 | 310% |
| Health Partners Of Kansas | $94 | 323% |
| Wppa | $95 | 327% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, Physical therapy (gait training), at Bob Wilson Memorial Hospital in Ulysses, KS, the facility's cash median rate is $40.00, which is significantly lower than the negotiated rates paid by insurance plans ranging from $32.00 to $95.00. While Medicare reimbursement for this service is set at $29.06, the facility's cash price of $40.00 is actually higher than the Medicare benchmark, suggesting that for patients with high-deductible plans, paying cash upfront might still result in lower out-of-pocket costs compared to the administrative fees and negotiated rates incurred by insurers. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit, church ownership, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these can further reduce the final amount owed.
When reviewing the billing statement for this service, consumers should be aware of the potential for balance billing if they are out-of-network, though the No Surprises Act protects against such charges for emergency and non-emergency services at in-network facilities. If a summary bill is received, it is crucial to request a full itemized audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors that can be corrected. Since the facility's negotiated rates for this procedure vary widely among payers, with UnitedHealthcare plans paying between $32.00 and $83.00, patients should compare these allowed amounts against the cash price and their specific plan deductibles to determine the most cost-effective payment