CMS Price Transparency Data
Physical therapy (gait training)
Facility: Uc San Diego Health Hillcrest - Hillcrest Med Ctr
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $84
- Cash Discount Price: $94
- vs. Medicare Baseline: 2.89x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Uc San Diego Health Hillcrest - Hillcrest Med Ctr is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.89x the Medicare baseline. Located in 200 West Arbor Drive, San Diego, CA.
Cash / Self-Pay
$94
Average discount available for prompt cash payment at this facility.
Insurance Median
$84
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: $94 (323%)
Insurance Median: $84 (289%)
Cash: $94 (323% of Medicare)
Ins. Median: $84 (289% 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 289% of the Medicare baseline (a markup of 189%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Alameda Alliance For Health [2027] | $13 | 45% |
| Alignment Health Plan [2020] | $13 | 45% |
| Alternate Medi-Cal [2001] | $13 | 45% |
| Blue Cross Blue Shield | $13 - $100 | 45% |
| Brand New Day [1089] | $13 | 45% |
| California Department Of Public Health [1237] | $13 | 45% |
| California Health & Wellness Medi-Cal [1122] | $13 | 45% |
| Caremore [2028] | $13 | 45% |
| Cms - County Medical Services [1025] | $13 - $110 | 45% |
| Community Care Ipa [1131] | $13 | 45% |
| Community Eldercare [1027] | $13 | 45% |
| Federal Prison [1031] | $13 | 45% |
| Gold Coast Health Plan [2031] | $13 | 45% |
| Health Plan Of San Joaquin [2032] | $13 | 45% |
| Hemet Community Med Grp - Promisecare [1040] | $13 | 45% |
| Imperial Health Holdings [1132] | $13 | 45% |
| Kern Health Systems [2033] | $13 | 45% |
| La Care Health Plan [2025] | $13 | 45% |
| Medi-Cal [1048] | $13 | 45% |
| Medicaid / KanCare | $13 | 45% |
| Regal Mg 'Heritage Provider Network' [2019] | $13 | 45% |
| San Diego County [1071] | $13 - $85 | 45% |
| Sd Physicians Med Grp [1076] | $13 - $110 | 45% |
| State Of California [1082] | $13 | 45% |
| UnitedHealthcare | $13 - $204 | 45% |
| Unlisted Mcal Hmo Non-Contract [1049] | $13 | 45% |
| Vantage [1092] | $13 - $102 | 45% |
| Ximed [2016] | $13 | 45% |
| Blue Shield Promise [1017] | $15 | 52% |
| Alternate Molina [1240] | $16 | 55% |
| Molina [1055] | $16 | 55% |
| Community Health Group [1022] | $17 | 58% |
| Health Net [1039] | $17 - $478 | 58% |
| Inland Empire Health Plan Transplant [1126] | $18 | 62% |
| Inland Empire Health Plan [1121] | $18 | 62% |
| Cal Optima [1016] | $19 | 65% |
| Aetna | $20 - $74 | 69% |
| Cigna | $20 - $102 | 69% |
| Humana | $20 - $144 | 69% |
| Mc Blue Shield Generic Payor [164016] | $20 | 69% |
| Mc Blue Shield Hmo [164015] | $20 | 69% |
| Mc Brand New Day Generic Payor [164031] | $20 | 69% |
| Mc Brand New Day Hmo [164030] | $20 | 69% |
| Mc Healthnet Generic Payor [164010] | $20 | 69% |
| Mc Healthnet Hmo [164004] | $20 | 69% |
| Mc Hnet Blue&Gold Aco [164017] | $20 | 69% |
| Mc Scan Generic Payor [164034] | $20 | 69% |
| Mc Scan Hmo [164035] | $20 | 69% |
| Uc Aff Blue Shield Sr/Sdsm [164037] | $20 | 69% |
| Padres Workers Compensation [2013] | $27 | 93% |
| Padres [2014] | $27 | 93% |
| Champva [1020] | $33 | 114% |
| Mid County Physicians Med Grp [1054] | $33 | 114% |
| Ucr Prompt Pay Payor [8240] | $35 | 120% |
| Multicultural Med Grp [1057] | $62 | 213% |
| Alternate Scan Health [2088] | $68 | 234% |
| Elizabeth Hospice [2018] | $68 | 234% |
| Scan Health [1072] | $68 | 234% |
| Blue Shield [1014] | $72 - $321 | 248% |
| Olympus Managed Healthcare Inc [1102] | $74 | 255% |
| Alternate Healthnet [1007] | $82 - $170 | 282% |
| Usoc - Us Olympic Committee [1123] | $84 | 289% |
| Global Excel [1036] | $85 | 292% |
| Sharp Health Plan [1079] | $85 - $112 | 292% |
| Alternate Sheriff Custody [1106] | $110 | 379% |
| Arch Health Partners [2000] | $110 | 379% |
| Axa Assistance [1098] | $110 | 379% |
| Cassidy Med Grp [1019] | $110 | 379% |
| Cmn - Canadian Medical Network [1024] | $110 | 379% |
| Ets - Lifetrac Network [1103] | $110 | 379% |
| Health Net Bh (Mhn) [1038] | $110 | 379% |
| Health Net Bh (Mhn) [2010] | $110 | 379% |
| Interlink Health Services Transplant [1124] | $110 | 379% |
| Interlink Health Transplant [2085] | $110 | 379% |
| Mgm Resorts [1053] | $110 | 379% |
| National Healthcare Solutions Inc [1100] | $110 | 379% |
| Quality Health [1069] | $110 | 379% |
| San Diego County Sheriff Custody [2012] | $110 | 379% |
| Scripps Coastal Med Grp [1074] | $110 | 379% |
| Tri-City [1085] | $110 | 379% |
| Graybill Med Grp [1037] | $112 | 385% |
| Sharp Community Med Grp [1078] | $112 | 385% |
| Sharp Rees Stealy [1080] | $112 | 385% |
| Kaiser [1046] | $114 | 392% |
| Alternate Health Net Bh [2059] | $116 | 399% |
| Embassy Sponsored [1101] | $116 - $119 | 399% |
| Healthnet Transplants [1114] | $116 | 399% |
| Interplan [1045] | $119 | 409% |
| Mercy Physicians Med Grp [1052] | $119 | 409% |
| Pacific Foundation [1063] | $119 | 409% |
| Beech Street [1012] | $128 | 440% |
| First Health [1032] | $128 | 440% |
| Admar [1001] | $131 | 451% |
| Bps - Benefit Plan Services [1015] | $131 | 451% |
| Multiplan [1058] | $131 | 451% |
| Private Healthcare Systems [1067] | $131 - $170 | 451% |
| Carnival Cruises [1018] | $136 | 468% |
| Alternate Kaiser Rad Onc [2089] | $170 | 585% |
| Chargers Football Company [1109] | $170 | 585% |
| Palomar Health [1128] | $204 | 702% |
| Easy Choice [1029] | $212 | 730% |
| Sharp Healthcare Transplant [1119] | $230 | 791% |
| Alternate Blue Shield [2002] | $321 | 1105% |
| Blue Shield Transplants [1113] | $321 | 1105% |