CMS Price Transparency Data
Physical therapy (gait training)
Facility: AHMC Anaheim Regional Medical Center
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $32
- Cash Discount Price: $137
- vs. Medicare Baseline: 1.10x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at AHMC Anaheim Regional Medical Center is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.10x the Medicare baseline. Located in 1111 W La Palma Avenue, Anaheim, CA.
Cash / Self-Pay
$137
Average discount available for prompt cash payment at this facility.
Insurance Median
$32
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: $137 (471%)
Insurance Median: $32 (110%)
Cash: $137 (471% of Medicare)
Ins. Median: $32 (110% 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.
Out-of-Pocket Cost Estimator
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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 |
|---|---|---|
| Allied Physicians | $9 - $48 | 31% |
| Applecare Medical Group | $9 | 31% |
| Heritage Provider Network | $9 - $43 | 31% |
| Non Contracted Medi-Cal | $9 | 31% |
| Talbert Medical Group | $9 - $55 | 31% |
| Ahmc Reciprocity Agreement | $11 - $41 | 38% |
| Altamed Health Network | $11 - $32 | 38% |
| Beverly Hospital | $11 - $35 | 38% |
| Brand New Day | $11 - $40 | 38% |
| Health Net | $11 | 38% |
| Healthcare Partners | $11 - $32 | 38% |
| Healthy Way La | $11 | 38% |
| Aids Health Foundation | $13 - $32 | 45% |
| Avanti | $13 - $38 | 45% |
| Caloptima | $13 - $32 | 45% |
| Emanate Health | $13 - $40 | 45% |
| Health Net Inc | $13 - $108 | 45% |
| Healthnet Cal Optima Medi-Cal/Healthy Families | $13 | 45% |
| Hollywood Presbyterian Advanced Med Mgmt Mcal | $13 | 45% |
| Hollywood Presbyterian Medpoint Mcal | $13 | 45% |
| Medi-Cal | $13 | 45% |
| Monarch Health Plan | $13 - $93 | 45% |
| Kaiser Foundation Hospitals | $16 - $32 | 55% |
| Medical Safety Net Program | $16 | 55% |
| Prospect Health Plan | $16 - $43 | 55% |
| Veterans Administration | $22 | 76% |
| Angels Baseball Workers Comp | $28 | 96% |
| Prospect Medical Group | $29 | 100% |
| Alta Los Angeles Hospital | $30 | 103% |
| Interplan | $30 - $96 | 103% |
| Tricare | $30 | 103% |
| Aetna | $32 - $86 | 110% |
| Alignment Health Plan | $32 | 110% |
| Apa Aco Inc | $32 | 110% |
| Blue Cross Blue Shield | $32 - $75 | 110% |
| Blue Shield Of California | $32 - $355 | 110% |
| California Health Plan | $32 | 110% |
| Central Health Of California | $32 | 110% |
| Cv-19 Hrsa Uninsured Testing And Tx I/P And O/P | $32 | 110% |
| Davita Heatlhcare Partners Plan Inc | $32 - $74 | 110% |
| First Health | $32 - $116 | 110% |
| Healthnet | $32 | 110% |
| Humana | $32 | 110% |
| Innovative Integrated Health (Iih)/Orange County Pace | $32 | 110% |
| Medicare (plans) | $32 - $68 | 110% |
| Monarch Healthcare Medical Group | $32 | 110% |
| Orange County Preferred Provider Organization | $32 - $103 | 110% |
| Pacificare | $32 | 110% |
| Private Pay Flat Rate | $32 | 110% |
| Scan Health Plan | $32 | 110% |
| Self-Pay | $32 | 110% |
| Seoul Medical Group | $32 | 110% |
| Wellcare | $32 | 110% |
| Align Senior Care | $33 | 114% |
| Athens Administrators | $33 | 114% |
| Capp Care | $33 - $103 | 114% |
| Cigna | $33 - $530 | 114% |
| Corvel | $33 - $103 | 114% |
| Marriot Intl | $33 | 114% |
| Nchp | $33 | 114% |
| Non Contracted Workers Comp | $33 | 114% |
| Netcare Life And Health Insurance | $34 | 117% |
| Ahmc Health Self-Insurance Epo | $40 | 138% |
| Knox-Keene Act | $40 | 138% |
| Advance Clinical Research Institute | $41 | 141% |
| Affiliated Doctors Of Orange County | $45 | 155% |
| Medical Acquisition Company | $55 | 189% |
| Healthcare Partners Commercial | $74 | 255% |
| Huntington Memorial Hospital | $74 | 255% |
| Msi/Medical Services For Indigents | $75 | 258% |
| Genesis Healthcare Ipa Ancillary | $82 | 282% |
| Affiliated Health Fund | $96 | 330% |
| Allnet Preferred Provider | $96 | 330% |
| Care First | $96 | 330% |
| Private Healthcare Systems | $96 | 330% |
| Memorial Healthcare Ipa | $100 | 344% |
| Choicecare | $103 | 354% |
| Multiplan Inc | $103 | 354% |
| National Provider Network | $110 | 379% |
| Three Rivers Providers Network | $110 | 379% |
| Health Payors Organization | $123 | 423% |
| Non Contracted Commercial | $137 | 471% |
| UnitedHealthcare | $198 - $344 | 681% |
| Memorial Healthcare Ipa/Cap/Valuation Rates | $1,403 | 4828% |