CMS Price Transparency Data

Physical therapy (gait training)

Facility: John Muir Medical Center - Walnut Creek Campus

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $162
Cash Discount Price: $145
vs. Medicare Baseline: 5.57x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at John Muir Medical Center - Walnut Creek Campus is $162. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $145. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.57x the Medicare baseline. Located in 1601 Ygnacio Valley Rd, Walnut Creek, CA.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$162

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: $145 (499%)

Insurance Median: $162 (557%)

Cash: $145 (499% of Medicare)

Ins. Median: $162 (557% 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 557% of the Medicare baseline (a markup of 457%). 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
Contra Costa County Jail [1012104]	$11	38%
Golden State-Network Mcare [1023127]	$33	114%
Jmpn Canopy Hn [1640000011]	$33	114%
UnitedHealthcare	$33 - $188	114%
Health Net-Network Mcare [1028127]	$35	120%
Aetna	$36 - $238	124%
Alignment Health [1177113]	$36	124%
Blue Cross Blue Shield	$36 - $504	124%
Blue Shield-Network Mcare [1006127]	$36	124%
Care 1St Health Plan [1094113]	$36	124%
Caremore [1171113]	$36	124%
Covid19 Hrsa Uninsured Testing And Treatment Fund [1179012]	$36	124%
Easy Choice Health Plan [1083113]	$36	124%
Essence Healthcare [1049028]	$36	124%
Essence Healthcare [1049128]	$36	124%
Generic Commercial/Indemnity [1017001]	$36 - $128	124%
Generic Hmo [1018103]	$36	124%
Generic Ppo [1021104]	$36	124%
Hospice Of East Bay [1085104]	$36	124%
Humana	$36 - $267	124%
Medicare (plans)	$36 - $257	124%
Scan-Network Mcare [1043127]	$36	124%
Tricare	$36	124%
Veterans Administration [1051113]	$36	124%
Workers' Comp [1024005]	$44	151%
Canopy Hn Hmo [1166103]	$65	224%
Carecentrix [1011001]	$128	440%
Aps Healthcare [1003103]	$145	499%
United Behavioral Health [1048103]	$162	557%
Cigna	$163 - $230	561%
Carelon Behavioral Health [1050104]	$177	609%
Fortified Provider Network [1063104]	$177	609%
Medigap [1036001]	$177	609%
Three Rivers Provider Network [1073104]	$177	609%
Health Net Hmo [1028103]	$183	630%
Health Net-Network [1028026]	$183	630%
Contra Costa Health Plan Hmo [1013103]	$193	664%
Blue Shield Hmo [1006103]	$199 - $204	685%
Blue Shield-Network [1006026]	$199 - $204	685%
Blue Shield Ppo [1006104]	$214 - $236	736%
Western Health Advantage Hmo [1053103]	$225 - $257	774%
Health Net Ppo [1028104]	$233	802%
Federal Correction Institute [1062104]	$257	884%
First Health [1016104]	$257 - $273	884%
Healthsmart - Pka Interplan [1031104]	$257	884%
National Provider Network/Plancare America [1069104]	$257	884%
Networks By Design [1084104]	$257	884%
Pponext [1072104]	$257	884%
Sutter Preferred Health Plan [1044104]	$257	884%
Kaiser Hmo [1033103]	$260	895%
Health Management Network [1066104]	$273	939%
Healthcomp [1089104]	$273 - $504	939%
Galaxy Health Network [1064104]	$289	994%
Integrated Health Plan [1075104]	$289	994%
Brms [1091104]	$504	1734%
Delta Health Systems [1032104]	$504	1734%
Empire Plan [1092104]	$504	1734%
Donor Network West [1008103]	$8,000	27529%

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 $145.
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 John Muir Medical Center - Walnut Creek Campus 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.