CMS Price Transparency Data

Physical therapy (gait training)

Facility: Othello Community Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $96
Cash Discount Price: $90
vs. Medicare Baseline: 3.30x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Othello Community Hospital is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.30x the Medicare baseline. Located in 315 North 14Th Avenue, Othello, WA.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $90 (310%)

Insurance Median: $96 (330%)

Cash: $90 (310% of Medicare)

Ins. Median: $96 (330% 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 330% of the Medicare baseline (a markup of 230%). 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	$51 - $52	175%
Amerigroup Mcaid	$51	175%
Chp Mcaid	$51	175%
Cocare - All Plans	$51	175%
Gau - All Plans	$51	175%
Kaiser - All Plans	$51	175%
Molina Mcaid	$51	175%
UnitedHealthcare	$51 - $120	175%
Chp - All Other Plans	$52	179%
Molina - All Other Plans	$52	179%
Medicare (plans)	$60	206%
Tricare	$78	268%
Triwest - All Plans	$78	268%
Asuris - All Plans	$96	330%
Commercial Other - All Plans	$96	330%
Hma - All Plans	$96	330%
Hmso - All Plans	$96	330%
Tpsc - All Plans	$96	330%
Travelers - All Plans	$96	330%
Veterans Admin - All Plans	$96	330%
Blue Cross Blue Shield	$101	348%
Cigna	$107	368%
First Choice - All Plans	$108	372%
Aetna	$113	389%
Chp Mcr Adv	$120	413%
Health Alliance Mcr Adv - All Plans	$120	413%
Humana	$120	413%
Molina Mcare	$120	413%
Wellcare Mcr Adv - 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 $90.
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 Othello Community 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.