Physical therapy (gait training)
Facility: San Antonio Regional Hospital
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $86
- Cash Discount Price: $249
- vs. Medicare Baseline: 2.96x 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 296% of the Medicare baseline (a markup of 196%). 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% |
| Healthnet Medi-Cal | $17 | 58% |
| Kaiser Medi-Cal | $17 | 58% |
| Alpha Care Mg Mcal/Hlthy Kids | $18 | 62% |
| Heritage Prov Ntwrk/Regal Mcal | $18 | 62% |
| Blue Cross Blue Shield | $19 - $360 | 65% |
| Molina Medi-Cal | $19 | 65% |
| Iehp Mcal | $21 | 72% |
| Tricare | $30 | 103% |
| Blue Shield Mcr Adv | $31 | 107% |
| Caremore Mcr Adv - All Plans | $31 | 107% |
| Choice Phycn Ntwrk Mcr Adv-All Other Plans | $31 | 107% |
| Healthnet Mcr Adv | $31 | 107% |
| Humana | $31 | 107% |
| Iehp Mcr Adv | $31 | 107% |
| Inter Valley Hp Mcr Adv- All Plans | $31 | 107% |
| Kindred Mcr Adv-All Plans | $31 | 107% |
| Molina Mcr Adv | $31 | 107% |
| Scan Health Plan Mcr Adv-All Plans | $31 | 107% |
| Universal Care - All Plans | $31 | 107% |
| Zelis Mcr Adv | $32 | 110% |
| Kasiser Mcr Adv | $33 | 114% |
| Imperial Health Mcr Adv-All Plans | $34 | 117% |
| Choice Phycn Ntwrk Op Only | $38 | 131% |
| Molina Exchange-All Other Plans | $40 | 138% |
| Aetna | $41 - $473 | 141% |
| Iehp Comm - All Other Plans | $44 | 151% |
| Redlands Employee | $46 | 158% |
| Redlands Hmo-All Other Plans | $48 | 165% |
| Prime Health - All Plans | $54 | 186% |
| Blue Shield Epn | $64 | 220% |
| Healthnet - All Other Plans | $73 | 251% |
| Kaiser Comm - All Other Plans | $85 | 292% |
| Ambetter / Centene | $86 | 296% |
| Coventry Ccn/First Hlth - All Plans | $120 | 413% |
| Epic Health Plan - All Other Plans | $142 | 489% |
| UnitedHealthcare | $180 - $270 | 619% |
| Pc Inland Valley Scan | $236 | 812% |
| Pc Inland Valley-All Other Plans | $236 | 812% |
| Blue Shield Epo Ppo - All Other Plans | $244 | 840% |
| Blue Shield Hmo Pos / Calpers Ppo | $244 | 840% |
| Choicecare Ntwrk-All Plans | $341 | 1173% |
| Multiplan/Phcs - All Plans | $341 | 1173% |
| Networks By Design - All Plans | $355 | 1222% |
| Zelis Comm-All Other Plans | $355 | 1222% |
| Foundation Inland Epo-All Other Plans | $378 | 1301% |
| Foundation Inland Ppo | $402 | 1383% |
| Health Payors - All Plans | $426 | 1466% |
| Interplan - All Plans | $426 | 1466% |
| Wellcare/Easy Choice-All Plans | $464 | 1597% |
| Alpha Care Mg Mcr Adv | $473 | 1628% |
| Central Hlth Plan Mcr Adv-All Plans | $473 | 1628% |
| Epic Health Plan Mcr Adv | $473 | 1628% |
| Prospect Hp-All Plans | $473 | 1628% |
| Providence Clevercare Mcr Adv | $473 | 1628% |
| Heritage Prov Ntwrk/Regal Mcr Adv | $480 | 1652% |
| Clever Care Mcr Adv - All Plans | $497 | 1710% |
| La Salle Hp Mcr Adv-All Plans | $497 | 1710% |
| Alpha Care Mg-All Other Plans | $591 | 2034% |
| Cigna | $599 | 2061% |
| Providence Oscar-All Other Plans | $686 | 2361% |
| Heritage Prov Ntwrk/Regal - All Other Plans | $869 | 2990% |