CMS Price Transparency Data

Physical therapy (gait training)

Facility: Paradise Valley Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $32
Cash Discount Price: $32
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Paradise Valley Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.10x the Medicare baseline. Located in 2400 East 4Th St, National City, CA.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $32 (110%)

Insurance Median: $32 (110%)

Cash: $32 (110% of Medicare)

Ins. Median: $32 (110% 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.

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
Aetna	$16 - $41	55%
Blue Sheid Of Promise	$16	55%
County Of San Diego	$16	55%
Golden Physicians Medical Group	$16 - $40	55%
Health Excel Ins	$16 - $32	55%
Heritage Provider Netwrok	$16 - $42	55%
Molina	$16 - $32	55%
Traditional Medi-Cal	$16	55%
UnitedHealthcare	$16 - $32	55%
Health Net Of Ca	$17 - $47	58%
Community Health Group	$19 - $32	65%
Blue Shield Of Ca, Va	$32	110%
Brand New Day	$32 - $48	110%
Ca Foundation For Medical Care	$32	110%
Central Health	$32	110%
Choice Physicians Network	$32	110%
Clever Care Of Golden State, Inc	$32	110%
Managed Health Network	$32	110%
Medicare (plans)	$32	110%
Renal Payer Solutions	$32	110%
Tricare	$32	110%
Usa Senior Care Network	$32	110%
Verda Health Plan	$32	110%
Imperial Health Plan Of Ca	$34	117%
Health Net Federal Service (Cdcr)	$40	138%
Veterans Evaluation Services	$40	138%
Integrated Medical Solutions	$42	145%
Worker Comp	$42	145%
Ca Dept Of Correction & Rehab	$45	155%
Employer Direct Healthcare	$45	155%
Naphcare	$50 - $64	172%
Scripps Health	$54	186%

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 $32.
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 Paradise Valley 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.