Physical therapy (gait training)
Facility: Adventist Health Simi Valley
Billing Code: 97116 (CPT)
- CPT Billing Code: 97116
- Insurance Median: $199
- Cash Discount Price: $49
- vs. Medicare Baseline: 6.85x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 685% of the Medicare baseline (a markup of 585%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Gold Coast Mcal - All Plans | $20 | 69% |
| Blue Shield Mcare | $32 | 110% |
| Facey Medical Mdcare | $32 | 110% |
| Medicare (plans) | $32 | 110% |
| Tricare | $32 | 110% |
| UnitedHealthcare | $32 - $203 | 110% |
| Facey Medical Hmo/Pos - All Other Plans | $38 | 131% |
| Ah Employee Health Plan - All Plans | $57 | 196% |
| Centivo - All Plans | $72 | 248% |
| Vchcp - All Plans | $122 | 420% |
| Ehn - All Plans | $125 | 430% |
| Kaiser - All Plans | $153 | 526% |
| Aetna | $168 | 578% |
| Cigna | $182 | 626% |
| Scan Mcr Adv - All Plans | $184 | 633% |
| First Health - All Plans | $199 | 685% |
| Phcs Ppo - All Plans | $199 | 685% |
| Hpn Senior Hmo | $204 | 702% |
| Beech Street Ppo - All Plans | $230 | 791% |
| Choicecare Ppo - All Plans | $230 | 791% |
| Health Net - All Plans | $237 | 816% |
| Corvel Corp - All Plans | $245 | 843% |
| Interplan Ppo - All Plans | $245 | 843% |
| Hpn - All Other Plans | $254 | 874% |
| Multiplan Ppo - All Plans | $254 | 874% |
| Ahf - All Plans | $260 | 895% |
| Hmn Ppo/Epo - All Plans | $260 | 895% |
| Trpn Ppo - All Plans | $260 | 895% |
| Fpn Ppo - All Plans | $275 | 946% |
| Western Growers - All Plans | $342 | 1177% |
| Blue Shield - All Other Plans | $357 | 1228% |
| Bc Exchange | $399 | 1373% |
| Bc Non Mcs | $446 | 1535% |
| Bc Mcs - All Other Plans | $536 | 1844% |