Physical therapy (gait training)
Facility: El Centro Regional Medical Center
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $116
- Cash Discount Price: $125
- vs. Medicare Baseline: 3.99x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 399% of the Medicare baseline (a markup of 299%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $30 - $254 | 103% |
| Brand New Day Comm - All Other Plans | $30 | 103% |
| Brand New Day Mcr | $30 | 103% |
| Healthnet Mcr Adv | $30 | 103% |
| Molina Mcr Adv | $30 | 103% |
| Scp Managed Care - All Plans | $30 | 103% |
| Tricare | $30 | 103% |
| UnitedHealthcare | $30 - $89 | 103% |
| Easy Choice Mcr Adv-All Plans | $34 | 117% |
| Healthnet Hmo | $38 | 131% |
| Cdcr Correctional-All Plans | $40 | 138% |
| Aetna | $78 | 268% |
| Pacificare-All Plans | $110 | 379% |
| Mulitplan Primary - All Other Plans | $121 | 416% |
| Cigna | $134 | 461% |
| Multiplan Comp | $142 | 489% |
| Trident - All Plans | $151 | 520% |
| Healthnet Comm-All Other Plans | $160 | 551% |
| Humana | $166 | 571% |
| Ahccs/Medi-Cal Misc - All Plans | $178 | 613% |
| Brand New Day Mcal | $178 | 613% |
| Medi-Cal | $178 | 613% |
| Molina Exchange - All Other Plans | $178 | 613% |
| Ambetter / Centene | $183 | 630% |
| Molina Mcal | $196 | 674% |
| Blue Shield-All Plans | $338 | 1163% |