CMS Price Transparency Data
Physical therapy (gait training)
Facility: Adventist Health White Memorial
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $102
- Cash Discount Price: $54
- vs. Medicare Baseline: 3.51x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Adventist Health White Memorial is $102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.51x the Medicare baseline. Located in 1720 Cesar E Chavez Avenue, Los Angeles, CA.
Cash / Self-Pay
$54
Average discount available for prompt cash payment at this facility.
Insurance Median
$102
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: $54 (186%)
Insurance Median: $102 (351%)
Cash: $54 (186% of Medicare)
Ins. Median: $102 (351% 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 351% of the Medicare baseline (a markup of 251%). 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 |
|---|---|---|
| Access Medi-Cal | $16 | 55% |
| Ahp Medi-Cal | $16 | 55% |
| Alta Los Angeles Mcal 1/1/19 | $16 | 55% |
| Avanti Mcal | $16 | 55% |
| Healthcare Inc Medi-Cal | $16 | 55% |
| Lasalle Mg Medi-Cal | $16 | 55% |
| Medi-Cal | $16 | 55% |
| Molina Medi-Cal | $16 | 55% |
| Pacific Alliance Medi-Cal | $16 | 55% |
| Pacific Ipa Medi-Cal | $16 | 55% |
| Preferred Ipa La Care Mcal Cap | $16 | 55% |
| Preferred Medi-Cal | $16 | 55% |
| Altamed Medi-Cal - All Other Plans | $19 | 65% |
| Fcs Ipa Medi-Cal Op/Profee Only | $19 | 65% |
| Healthnet Mcal | $19 | 65% |
| Preferred Healthy | $20 | 69% |
| Bc Medi-Cal | $21 | 72% |
| Assoc Hispanic Physcns Mcal | $23 | 79% |
| Access Group | $27 | 93% |
| Ahp - All Other Plans | $27 | 93% |
| Lasalle Mg Commercial - All Other Plans | $27 | 93% |
| Access Senior - All Other Plans | $32 | 110% |
| Ahp Senior | $32 | 110% |
| Alta Los Angeles Mcr 1/1/19-All Other Plans | $32 | 110% |
| Altamed Connect | $32 | 110% |
| Avanti Mcr Adv - All Other Plans | $32 | 110% |
| Brand New Day Mcare - All Plans | $32 | 110% |
| Bs Va Mcare | $32 | 110% |
| Care First Mcare - All Other Plans | $32 | 110% |
| Clever Care - All Plans | $32 | 110% |
| Fcs Ipa Mcr Advan Op/Profee Only | $32 | 110% |
| Humana | $32 | 110% |
| Lasalle Mg Senior | $32 | 110% |
| Medicare (plans) | $32 | 110% |
| Molina Mcare | $32 | 110% |
| Pacific Alliance Mcare - All Other Plans | $32 | 110% |
| Preferred Senior | $32 | 110% |
| Sunlight Living Hlth Mcr Adv-All Other Plans | $32 | 110% |
| Tricare | $32 | 110% |
| UnitedHealthcare | $32 - $188 | 110% |
| Blue Cross Blue Shield | $33 - $549 | 114% |
| Fcs Ipa Op/Profee Only - All Other Plans | $34 | 117% |
| Bright Health - All Plans | $37 | 127% |
| Assoc Hispanic Physcns Hmo/Mcr Adv-All Other Plans | $38 | 131% |
| Preferred Commercial - All Other Plans | $38 | 131% |
| Blue Shield Medi-Cal | $40 | 138% |
| Intergrated Medical - All Plans | $42 | 145% |
| Molina Benefit Exchange - All Other Plans | $43 | 148% |
| Php-Prospect Health Plan Cap - All Plans | $48 | 165% |
| Care First Medi-Cal | $57 | 196% |
| Ah Employee Health Plan - All Plans | $58 | 200% |
| Centivo - All Plans | $72 | 248% |
| Bella Vista Mcr Adv Op/Profee Only - All Other Pla | $80 | 275% |
| Bella Vista Medi-Cal Op/Profee Only | $80 | 275% |
| Aetna | $91 | 313% |
| Pacific Ipa - All Other Plans | $91 - $137 | 313% |
| Kaiser- All Plans | $98 - $148 | 337% |
| Cigna | $102 - $153 | 351% |
| Blue Shield Mcr Adv | $105 | 361% |
| Healthnet - All Other Plans | $109 - $163 | 375% |
| Healthnet Comm Care | $112 - $168 | 385% |
| Hcpamg - All Plans | $120 - $181 | 413% |
| Healthcare Inc - All Other Plans | $132 - $199 | 454% |
| La Care Mcr Adv - All Plans | $132 - $199 | 454% |
| First Heatlh Ppo - All Plans | $139 - $209 | 478% |
| Caremore Mcare - All Plans | $154 | 530% |
| Phcs Ppo - All Plans | $156 - $235 | 537% |
| Scan Health Mcare - All Plans | $156 - $235 | 537% |
| Ahf - All Plans | $180 - $271 | 619% |
| Beech Street - All Plans | $180 - $271 | 619% |
| Interplan Ppo - All Plans | $180 - $271 | 619% |
| Corvel Corp - All Plans | $192 - $289 | 661% |
| Multiplan Ppo - All Plans | $199 - $300 | 685% |
| Healthmannet - All Plans | $204 - $307 | 702% |
| Next Inc Ppo - All Plans | $204 - $307 | 702% |
| Trpn - All Plans | $204 - $307 | 702% |
| Fpn Ppo - All Plans | $216 - $325 | 743% |
| Western Growers/Pinnacle - All Plans | $341 | 1173% |
| Healthnet Mcr Adv | $367 - $552 | 1263% |
| Blue Shield Epn | $460 | 1583% |
| Blue Shield - All Other Plans | $530 | 1824% |