CMS Price Transparency Data

Physical therapy (gait training)

Facility: Sharp Coronado Hospital and Hlthcr Ctr

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $91
Cash Discount Price: $136
vs. Medicare Baseline: 3.13x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Sharp Coronado Hospital and Hlthcr Ctr is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $136. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.13x the Medicare baseline. Located in 250 Prospect Place, Coronado, CA.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$91

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: $136 (468%)

Insurance Median: $91 (313%)

Cash: $136 (468% of Medicare)

Ins. Median: $91 (313% 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 313% of the Medicare baseline (a markup of 213%). 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
UnitedHealthcare	$25	86%
Aetna	$27 - $115	93%
Blue Shield	$27 - $120	93%
Community Health Group	$27 - $87	93%
Medi-Cal	$51 - $76	175%
Health Net	$54 - $163	186%
Molina	$54 - $115	186%
Cigna	$62 - $145	213%
Allianz Global Assistance	$100	344%
Humana	$102	351%
Blue Cross Blue Shield	$112 - $127	385%
Managed Health Network	$113 - $136	389%
Interplan	$115	396%
Multiplan	$122	420%
County Medical Services	$127	437%
Medicare (plans)	$127	437%

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 $136.
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 Sharp Coronado Hospital and Hlthcr Ctr 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.