CMS Price Transparency Data

Physical therapy (gait training)

Facility: Lincoln Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $70
Cash Discount Price: $79
vs. Medicare Baseline: 2.41x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Lincoln Hospital is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.41x the Medicare baseline. Located in 10 Nichols Street, Davenport, WA.

Cash / Self-Pay

$79

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $79 (272%)

Insurance Median: $70 (241%)

Cash: $79 (272% of Medicare)

Ins. Median: $70 (241% 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 241% of the Medicare baseline (a markup of 141%). 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
Ambetter / Centene	$41	141%
Molina Hlthy Options	$41	141%
UnitedHealthcare	$41 - $77	141%
Amerigroup Mcaid - All Plans	$43	148%
Aetna	$49 - $83	169%
Indian Hlth Services - All Plans	$49	169%
Tricare	$49	169%
Va Ccn - All Plans	$49	169%
Labor & Industries - All Plans	$54	186%
Cigna	$67	231%
Focus Healthcare Mgmt - All Plans	$70	241%
Molina Exchange-All Other Plans	$70	241%
Blue Cross Blue Shield	$77	265%
Uniform Medical Plan-All Plans	$77	265%
First Health Coventry-All Plans	$78	268%
Health Management Network-All Plans	$79	272%
Three Rivers-All Plans	$79	272%
Asuris Nw Health-All Plans	$81	279%
Multiplan-All Plans	$83	286%
Physician Hosp Comm Org-All Plans	$83	286%
First Choice Health- All Plans	$85	292%

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 $79.
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 Lincoln Hospital 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.