CMS Price Transparency Data

Physical therapy (gait training)

Facility: City of Hope National Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $120
Cash Discount Price: $138
vs. Medicare Baseline: 4.13x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at City of Hope National Medical Center is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $138. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.13x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$138

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $138 (475%)

Insurance Median: $120 (413%)

Cash: $138 (475% of Medicare)

Ins. Median: $120 (413% 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 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.

Consult Patient Advocate

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
Health Net	$9 - $174	31%
Heritage Provider Network	$11 - $104	38%
Cal Optima	$13 - $32	45%
Inland Empire	$19 - $119	65%
Prime Healthcare Keenan	$56 - $143	193%
Blue Cross Blue Shield	$63 - $297	217%
UnitedHealthcare	$71 - $297	244%
Blue Shield	$75 - $297	258%
Blue Shield Promise	$89 - $104	306%
Cencal	$101 - $119	348%
La Care Health	$101 - $119	348%
Kaiser	$114 - $134	392%
Aetna	$126 - $148	434%
Gold Coast	$126 - $148	434%
Molina	$126 - $193	434%
Cigna	$136 - $159	468%
Facey	$139 - $163	478%
Healthcare Partners	$147 - $172	506%
St. Joseph Heritage	$152 - $178	523%
Primecare Medical Network	$164 - $193	564%
First Health	$195 - $229	671%
Phcs Multiplan	$228 - $267	785%
Blue Shield Covca	$238	819%

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 $138.
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 City of Hope National Medical Center 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.