CMS Price Transparency Data

Physical therapy (gait training)

Facility: Prosser Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $127
Cash Discount Price: $87
vs. Medicare Baseline: 4.37x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Prosser Memorial Hospital is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.37x the Medicare baseline. Located in 723 Memorial Street, Prosser, WA.

Cash / Self-Pay

$87

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

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: $87 (299%)

Insurance Median: $127 (437%)

Cash: $87 (299% of Medicare)

Ins. Median: $127 (437% 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 437% of the Medicare baseline (a markup of 337%). 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
Kaiser Permanente	$32 - $145	110%
Community Health Plan Of Washington	$34 - $64	117%
Coordinated Care	$34 - $64	117%
UnitedHealthcare	$34 - $135	117%
Amerigroup	$36 - $68	124%
Molina	$36 - $64	124%
Health Alliance Northwest	$40	138%
Humana	$40 - $135	138%
Wellcare	$40	138%
Aetna	$48 - $135	165%
Ambetter / Centene	$111 - $122	382%
Asuris	$127 - $143	437%
Health Management Adminstrators	$127 - $143	437%
Premera	$127	437%
Regence	$127 - $143	437%
Cigna	$130	447%
First Choice	$135	465%
Multiplan	$135 - $143	465%

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 $87.
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 Prosser Memorial 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.