CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mid-Columbia Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $59
Cash Discount Price: $52
vs. Medicare Baseline: 2.03x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mid-Columbia Medical Center is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.03x the Medicare baseline. Located in 1700 E 19Th Street, The Dalles, OR.

Cash / Self-Pay

$52

Average discount available for prompt cash payment at this facility.

Insurance Median

$59

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: $52 (179%)

Insurance Median: $59 (203%)

Cash: $52 (179% of Medicare)

Ins. Median: $59 (203% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 203% of the Medicare baseline (a markup of 103%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Blue Cross Blue Shield	$29 - $395	100%
Community Hp Mcr Adv - All Plans	$29	100%
Healthnet Mcr Adv	$29	100%
Moda Mcr Adv	$29 - $30	100%
Molina Mcr Adv	$29	100%
Tricare	$29	100%
Va Ccn Triwest - All Plans	$29	100%
Humana	$30	103%
Devoted Mcr Adv - All Plans	$31 - $134	107%
Employee Health Plan - All Plans	$32 - $52	110%
Molina - All Other Plans	$32	110%
Healthnet - All Other Plans	$41	141%
Cigna	$48 - $117	165%
Molina Mcaid	$49 - $64	169%
Multiplan/Phcs - All Plans	$49 - $118	169%
Coventry - All Plans	$53 - $112	182%
Aetna	$54 - $114	186%
First Choice - All Plans	$54 - $118	186%
Providence Ppo - All Plans	$58 - $118	200%
Moda Health Plan - All Other Plans	$59 - $82	203%
Norocor - All Plans	$62	213%
Amerigroup Mcaid - All Plans	$64 - $94	220%
Coordinated Care Mcaid - All Plans	$64 - $94	220%
UnitedHealthcare	$64 - $118	220%
Healthscape - All Plans	$99	341%
First Health - All Plans	$110	379%
Pacific Source - All Plans	$114	392%
Trpn - Three Rivers - All Plans	$118	406%
Ahp - Americas Hlth Plan - All Plans	$120	413%

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 $52.
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 Mid-Columbia Medical Center 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.