Physical therapy (gait training)
Facility: Salina Regional Health Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $50
- Cash Discount Price: $49
- vs. Medicare Baseline: 1.72x 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 |
|---|---|---|
| Preferred Phsic | $27 - $57 | 93% |
| Preferred Healthcare - All Other Plans | $36 - $76 | 124% |
| Providers Care (Wppa)-All Plans | $40 - $85 | 138% |
| Cigna | $40 - $85 | 138% |
| Multiplan (Mpi)-All Plans | $40 - $85 | 138% |
| Aetna | $40 - $85 | 138% |
| Blue Cross Blue Shield | $49 - $51 | 169% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Salina Regional Health Center in Salina, Kansas, the cash median price is $49.00, which is 1.7 times the Medicare benchmark rate of $29.06. While the facility offers a median negotiated rate of $50.00 to in-network payers, this amount is slightly higher than the cash price, illustrating that paying out-of-pocket can sometimes be more cost-effective for patients with high deductibles. The facility's negotiated rates range from $27 to $85 across seven different insurance plans, with Preferred Phsic offering the lowest range at $27 to $57. Because commercial rates often include administrative overhead and contract markups, patients should verify their specific plan's allowed amount before scheduling, as the negotiated ceiling does not guarantee the lowest possible price.
To maximize savings, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront. Since the cash median of $49.00 is lower than the median negotiated rate of $50.00, paying in full avoids the administrative costs and potential markups associated with insurance processing. Additionally, if you have out-of-network coverage or are concerned about balance billing, it is crucial to request a detailed, itemized bill before paying any amount. This allows you to review specific CPT codes and identify any unbundled charges or services not rendered, ensuring you are only paying for the actual care provided. Always confirm your deductible status and ask for a waiver of insurance submission if you choose