CMS Price Transparency Data

Physical therapy (gait training)

Facility: Arbor Health Morton Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $66
Cash Discount Price: $86
vs. Medicare Baseline: 2.27x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Arbor Health Morton Hospital is $66. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.27x the Medicare baseline. Located in 521 Adams Street, Morton, WA.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$66

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: $86 (296%)

Insurance Median: $66 (227%)

Cash: $86 (296% of Medicare)

Ins. Median: $66 (227% 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 227% of the Medicare baseline (a markup of 127%). 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
Comm Health Healthy Options	$58 - $62	200%
Kaiser Mcaid	$58 - $62	200%
UnitedHealthcare	$58 - $114	200%
Amerigroup-All Other Plans	$61 - $65	210%
Aetna	$62 - $126	213%
Amerigroup Mcr Adv	$62 - $66	213%
Comm Health Mcr Adv	$62 - $66	213%
Healthnet Mcr Adv - All Plans	$62 - $66	213%
Humana	$62 - $66	213%
Mcr Railroad Mcr Adv - All Plans	$62 - $66	213%
Medicare (plans)	$62 - $66	213%
Premera Hmo Mcr Adv	$62 - $66	213%
Regence Blue Shield Mcr Adv	$62 - $66	213%
Rural Health Mcare - All Plans	$62 - $66	213%
Molina Mcr Adv	$65 - $69	224%
Wellcare Mcr Adv - All Plans	$65 - $69	224%
Molina Marketplace-All Other Plans	$79 - $84	272%
Regence Blue Shield Ump-All Other Plans	$94 - $100	323%
Kaiser Comm-All Other Plans	$105 - $112	361%
Molina Mcaid	$111 - $119	382%
Comm Health Basic Sub - All Other Plans	$114 - $122	392%
Comm Health Pebb	$114 - $122	392%
Premera First-All Other Plans	$121 - $129	416%
Cigna	$125 - $133	430%
First Choice-All Plans	$125 - $133	430%

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 $86.
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 Arbor Health Morton 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.