CMS Price Transparency Data

Physical therapy (gait training)

Facility: Deaconess Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $49
Cash Discount Price: $68
vs. Medicare Baseline: 1.69x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Deaconess Medical Center is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.69x the Medicare baseline. Located in W 800 Fifth Avenue, Spokane, WA.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$49

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: $68 (234%)

Insurance Median: $49 (169%)

Cash: $68 (234% of Medicare)

Ins. Median: $49 (169% 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
Coordinated Care	$18	62%
Molina	$18	62%
UnitedHealthcare	$18 - $33	62%
Wellpoint	$18	62%
Community Health Plan Of Washington	$19	65%
Premera	$37 - $48	127%
Pacificsource	$45 - $49	155%
Regence/Asuris	$53	182%
First Choice	$65 - $118	224%
Aetna	$76	262%
Cigna	$95	327%
First Health	$120	413%
Multiplan/Phcs	$123	423%
Kaiser	$145	499%

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 $68.
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 Deaconess 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.