CMS Price Transparency Data

Physical therapy (gait training)

Facility: Antelope Valley Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $37
Cash Discount Price: $137
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Antelope Valley Hospital is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.27x the Medicare baseline. Located in 1600 W Ave J, Lancaster, CA.

Cash / Self-Pay

$137

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $137 (471%)

Insurance Median: $37 (127%)

Cash: $137 (471% of Medicare)

Ins. Median: $37 (127% 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
Alignment Healthcare	$32	110%
Central Health Plan Of California	$32	110%
Citizens Choice Healthplan	$32	110%
Health Net Of California	$32 - $45	110%
L.A. Care Health Plan	$32	110%
Wellcare	$32	110%
For Your Benefit	$33	114%
Humana	$33	114%
Brand New Day	$34	117%
Aids Foundation	$37	127%
Align Senior Care Ca	$37	127%
Champion Health Plan	$37	127%
Clever Care Health Plan	$38	131%
Ca State Prison	$42	145%
Oscar Hp/Providence Health Network	$48	165%
Kaiser Foundation Hospitals	$71	244%
Aetna	$201	692%
Blue Shield	$274	943%
Cigna	$338	1163%
Blue Shield Of California	$550	1893%

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 $137.
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 Antelope 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.