Physical therapy (gait training)
Facility: Sonoma Valley Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $120
- Cash Discount Price: $183
- vs. Medicare Baseline: 4.13x 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 413% of the Medicare baseline (a markup of 313%). 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 |
|---|---|---|
| Medi-Cal | $16 | 55% |
| Aetna | $22 | 76% |
| First Health(Coventry)-All Plans | $22 | 76% |
| Mcal Mgd Care (Php)-All Plans | $27 | 93% |
| Blue Cross Blue Shield | $32 - $241 | 110% |
| Bright Hlth/Brand New Day Mcr Adv | $32 | 110% |
| Hospice Of Marin-All Plans | $32 | 110% |
| Meritage Medical Network Op Only Mcare | $32 | 110% |
| St Joseph Heritage Hltcare Comm-All Other Plans | $32 | 110% |
| Tricare | $32 | 110% |
| Veterans Admin-All Plans | $32 | 110% |
| Marin General Comm/Mcr Adv (Western Hlth)-All Plan | $34 | 117% |
| Cdcr Prison-All Plans | $39 | 134% |
| Three Rivers (Trpn)-All Plans | $39 | 134% |
| Meritage Medical Network Op Only-All Other Plans | $41 | 141% |
| Chp - Correctional Health Partners - All Plans | $42 | 145% |
| Bright Hlth/Brand New Day - All Other Plands | $44 | 151% |
| Wellpath - All Plans | $45 | 155% |
| Partnership Healthplan-All Plans | $57 | 196% |
| Canopy Bay Area Accountable Care Ntwrk (Baacn) - A | $58 | 200% |
| Canopy Health Solutions-All Other Plans | $58 | 200% |
| Healthnet Hmo/Ppo-All Other Plans | $91 | 313% |
| Blue Shield Ppo-All Plans | $148 | 509% |
| Kaiser-All Plans | $170 | 585% |
| Integrated Health Plan-All Plans | $193 | 664% |
| Phcs/Multiplan/Beech St-All Plans | $196 | 674% |
| Champus-All Plans | $209 | 719% |
| Cigna | $209 | 719% |
| Networks By Design - All Plans | $209 | 719% |
| Comm Care Network(Ccn)-All Plans | $222 | 764% |
| Great West-One Health Plan Ppo/Pos-All Plans | $222 | 764% |
| Interplan-All Plans | $230 | 791% |
| Bps-All Plans | $235 | 809% |
| Ppo Alliance-All Plans | $235 | 809% |
| Pref Health Networl(Phn)-All Plans | $235 | 809% |
| Scan Mcare-All Plans | $261 | 898% |
| St Joseph Heritage Hltcare Mcr Adv | $261 | 898% |
| Correct Care Integ Health-All Plans | $313 | 1077% |
| Employer Direct Healthcare-All Plans | $313 | 1077% |
| Creative Legal Services-All Plans | $339 | 1167% |
| UnitedHealthcare | $421 | 1449% |
| Canopy Op Only | $470 | 1617% |
| Vnpn - All Plans | $470 | 1617% |