Physical therapy (gait training)
Facility: Susan B Allen Memorial Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $554
- Cash Discount Price: $60
- vs. Medicare Baseline: 19.06x 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 1906% of the Medicare baseline (a markup of 1806%). 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 | $350 | 1204% |
| Providrs Care | $757 | 2605% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Susan B Allen Memorial Hospital in El Dorado, KS, the cash median price is $60.00, which is significantly lower than the facility's gross charge of $92.00. While the hospital's negotiated rates with UnitedHealthcare and Providrs Care are $350 and $757 respectively, patients with high-deductible plans may find the cash price more advantageous if their insurance allowed amount exceeds $60.00. It is important to note that the facility does not currently list a median paid amount, so patients should verify their specific plan's allowed amount before scheduling. Additionally, the facility offers voluntary non-profit ownership and is located in a rural area of Kansas, which may influence local pricing dynamics compared to urban centers.
When evaluating the cost of this service, it is helpful to compare the cash price against the Medicare benchmark, which stands at $29.06 for this procedure. The cash rate of $60.00 is approximately 19.1% higher than the Medicare amount, reflecting the typical administrative and clinical costs associated with outpatient care. Patients should be aware that hospitals often offer prompt-pay discounts, typically ranging from 20% to 50%, for those who settle their bill in full upfront. To secure these discounts, patients must request self-pay classification and waive insurance submission prior to check-in, as automatic claims processing can void any cash agreement. Furthermore, since the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should avoid signing out-of-network cost waivers for mandatory ancillary services.