CMS Price Transparency Data

Physical therapy (gait training)

Facility: Washington County Hospital and Clinics

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $39
Cash Discount Price: $69
vs. Medicare Baseline: 1.34x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Washington County Hospital and Clinics is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.34x the Medicare baseline. Located in 400 East Polk Street, Washington, IA.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $69 (237%)

Insurance Median: $39 (134%)

Cash: $69 (237% of Medicare)

Ins. Median: $39 (134% of 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$34 - $102	117%
Blue Cross Blue Shield	$37 - $249	127%
Health Alliance Mcr Adv	$37	127%
Med Assoc Mcr Adv	$37	127%
Healthpartners Mcr Adv	$38	131%
Humana	$38	131%
Ia Total Care Wellcare Mcr Adv	$38	131%
Molina Mcr Adv - All Other Plans	$38	131%
Wellpoint Mcr Adv Amerigrp - All Other Plans	$38	131%
Ia Total Care Mcaid	$39	134%
Medicaid / KanCare	$39	134%
Wellpoint Mcaid Amerigrp	$39	134%
Ambetter / Centene	$43	148%
Healthpartners - All Other Plans	$78	268%
Midlands Choice - All Plans	$78	268%
Health Alliance Comm - All Other Plans	$87	299%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $69.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97116.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Washington County Hospital and Clinics is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97116.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.