CMS Price Transparency Data
Physical therapy (gait training)
Facility: Seattle Children's Hospital
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $170
- Cash Discount Price: $233
- vs. Medicare Baseline: 5.85x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Seattle Children's Hospital is $170. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $233. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.85x the Medicare baseline. Located in 4800 Sand Point Way Ne, Po Box C-5371, Seattle, WA.
Cash / Self-Pay
$233
Average discount available for prompt cash payment at this facility.
Insurance Median
$170
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: $233 (802%)
Insurance Median: $170 (585%)
Cash: $233 (802% of Medicare)
Ins. Median: $170 (585% 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 585% of the Medicare baseline (a markup of 485%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Child Hearing League [17301] | $17 | 58% |
| Hospice [17306] | $17 | 58% |
| Maple Lane School [17309] | $17 | 58% |
| Medicaid / KanCare | $17 | 58% |
| Chpw [15802] | $18 | 62% |
| Coordinated Care [15815] | $18 | 62% |
| Eye Quest [15894] | $18 | 62% |
| Icw Wellpoint [15822] | $18 | 62% |
| Kaiser [15818] | $18 | 62% |
| Molina [15809] | $18 | 62% |
| Opticare [15895] | $18 | 62% |
| UnitedHealthcare | $18 - $245 | 62% |
| Wellpoint [15814] | $18 | 62% |
| Ubh Community & State [15819] | $22 | 76% |
| Usfhp [12208] | $73 - $118 | 251% |
| Asuris [11913] | $96 - $156 | 330% |
| Bridgespan Health Company [11906] | $96 - $156 | 330% |
| Premera [11600] | $96 - $239 | 330% |
| Regence [11903] | $96 - $239 | 330% |
| Regence [11909] | $96 - $156 | 330% |
| Chpw Cascade [12228] | $98 - $159 | 337% |
| Coordinated Care [12267] | $98 - $216 | 337% |
| Kaiser [13400] | $98 - $216 | 337% |
| Kaiser [13401] | $116 - $187 | 399% |
| Regence Ump [12263] | $116 - $187 | 399% |
| Administrators [13102] | $134 - $245 | 461% |
| Molina Marketplace [12831] | $134 - $216 | 461% |
| Asuris [11900] | $148 - $239 | 509% |
| Blue Cross Blue Shield | $148 - $239 | 509% |
| Aetna | $150 - $242 | 516% |
| Ameriben [11006] | $150 - $242 | 516% |
| Christian Brothers [11001] | $150 - $242 | 516% |
| Coresource [11004] | $150 - $242 | 516% |
| Ebms [11003] | $150 - $242 | 516% |
| Meritain [12251] | $150 - $274 | 516% |
| Moda [11009] | $150 - $242 | 516% |
| Preferred One [11008] | $150 - $242 | 516% |
| Web Tpa [11007] | $150 - $242 | 516% |
| Allegiance [12264] | $152 - $245 | 523% |
| Allied [13129] | $152 - $245 | 523% |
| Assurant Health Fc [13135] | $152 - $245 | 523% |
| Carpenters Trust [13100] | $152 - $245 | 523% |
| Cigna | $152 - $245 | 523% |
| Coastal Administrative [13140] | $152 - $245 | 523% |
| Coventry Fc [13112] | $152 - $245 | 523% |
| Ebms Fc [13144] | $152 - $245 | 523% |
| First Choice [13399] | $152 - $245 | 523% |
| Guardian Fc [13105] | $152 - $245 | 523% |
| Health Alliance [13233] | $152 - $245 | 523% |
| Ilwu-Pma [13158] | $152 - $245 | 523% |
| Kps [13109] | $152 - $245 | 523% |
| Loomis Benefits West [13161] | $152 - $245 | 523% |
| Mega Life [13111] | $152 - $245 | 523% |
| Meritain Health [13229] | $152 - $245 | 523% |
| Moda Fc [13219] | $152 - $245 | 523% |
| Myers Stevens & Toohey [13169] | $152 - $245 | 523% |
| Pacific Underwriters [13175] | $152 - $245 | 523% |
| Personify Fc [13155] | $152 - $245 | 523% |
| Personify [12270] | $152 - $245 | 523% |
| Principal Mutual Fc [13115] | $152 - $245 | 523% |
| Providence Health Plan [12289] | $152 - $245 | 523% |
| Providence Health Plan [13181] | $152 - $245 | 523% |
| Psew [13124] | $152 - $245 | 523% |
| Rehn & Associates [13182] | $152 - $245 | 523% |
| Sound Health And Wellness [13116] | $152 - $245 | 523% |
| Starmark [13103] | $152 - $245 | 523% |
| Tongass Timber Trust [13202] | $152 - $245 | 523% |
| Trusteed Plans [13186] | $152 - $245 | 523% |
| Trustmark Life Insurance [13203] | $152 - $245 | 523% |
| Tufts Health Plan [12279] | $152 - $245 | 523% |
| Welfare Pension [13120] | $152 - $245 | 523% |
| Wship [13121] | $152 - $245 | 523% |
| Zenith American Solutions [13195] | $152 - $245 | 523% |
| Zenith [13123] | $152 - $245 | 523% |
| United Behavioral Health [12234] | $157 - $254 | 540% |
| Coastal Admin Svcs Contracted [12222] | $161 - $259 | 554% |
| Personify Contracted [12205] | $161 - $259 | 554% |
| Claritev [12299] | $170 - $274 | 585% |
| Ebms [12241] | $170 - $274 | 585% |
| Health Alliance [12266] | $170 - $274 | 585% |
| Humana | $170 - $274 | 585% |
| Key Benefit Admin [12276] | $170 - $274 | 585% |
| Medical Mutual [12233] | $170 - $274 | 585% |
| Moda [12842] | $170 - $274 | 585% |
| Nippon Life Insurance [12232] | $170 - $274 | 585% |
| Pehp [12235] | $170 - $274 | 585% |
| Preferredone Admin Services [12236] | $170 - $274 | 585% |
| Select Health [12277] | $170 - $274 | 585% |
| Altius Health Plan [12275] | $171 - $277 | 588% |
| Coventry Mhbp [12272] | $171 - $277 | 588% |
| Coventry [12244] | $171 - $277 | 588% |
| First Health [12210] | $171 - $277 | 588% |
| Hcc Medical [12274] | $171 - $277 | 588% |
| Lewermark [12286] | $171 - $277 | 588% |
| Medishare [12287] | $171 - $277 | 588% |
| Pacificsource [12245] | $171 - $277 | 588% |
| Rural Carrier Benefit Plan [12271] | $171 - $277 | 588% |