Physical therapy (gait training)
Facility: Lindsborg Community Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $44
- Cash Discount Price: $49
- vs. Medicare Baseline: 1.51x 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 |
|---|---|---|
| Coventry Mcr Adv | $21 - $45 | 72% |
| Tricare | $21 - $44 | 72% |
| Cigna | $38 - $80 | 131% |
| UnitedHealthcare | $40 - $85 | 138% |
| Coventry Comm-All Other Plans | $40 - $85 | 138% |
| Multiplan-All Plans | $42 - $88 | 145% |
| Phcs Preferred-All Plans | $42 - $88 | 145% |
| Health Partners -All Plans | $43 - $90 | 148% |
| Wppa-All Plans | $43 - $90 | 148% |
| Century Health-All Plans | $43 - $90 | 148% |
| Coventry Wc | $43 - $90 | 148% |
| Blue Cross Blue Shield | $46 | 158% |
Consumer Guidance & Cost Commentary
For the CPT code 97116, representing physical therapy gait training at Lindsborg Community Hospital in Kansas, the cash median price is $49.00, while the median amount paid by insurance is $44.00. This service is benchmarked against the Medicare rate of $29.06, showing a 1.5x markup relative to the federal baseline. While the facility is a Critical Access Hospital in a Voluntary non-profit setting, the negotiated rates for major payers like Cigna, UnitedHealthcare, and Coventry range from $38 to $90, which exceeds the cash price. For patients with high-deductible plans, paying the cash median of $49.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often surpass the direct cash price due to administrative overheads.
Patients should verify if the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final cost significantly. It is important to request an itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. By demanding a line-by-line statement showing specific CPT codes and unit costs, consumers can identify double-billing or charges for cancelled supplies. Additionally, since the No Surprises Act prohibits balance billing for out-of-network providers at in-network facilities, patients should dispute any surprise bills immediately rather than paying them out of fear of credit damage.