CMS Price Transparency Data

Physical therapy (gait training)

Facility: Loma Linda University Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $185
Cash Discount Price: $123
vs. Medicare Baseline: 6.37x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Loma Linda University Medical Center is $185. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 6.37x the Medicare baseline. Located in 11234 Anderson St, Loma Linda, CA.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$185

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: $123 (423%)

Insurance Median: $185 (637%)

Cash: $123 (423% of Medicare)

Ins. Median: $185 (637% 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 637% of the Medicare baseline (a markup of 537%). 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
Inland Empire Health Plan (Iehp)	$19	65%
Kaiser Foundation Hospitals	$21 - $218	72%
Adventist Health	$44 - $134	151%
Lluh Dept Of Risk Management	$44 - $134	151%
Epic Health Plan	$87 - $131	299%
Riverside University Health System	$87 - $131	299%
Alpha Care Medical Group	$120 - $278	413%
Global Benefits Group	$131 - $196	451%
Temecula Valley Physicians Medical Group	$131 - $196	451%
Trivalley Medical Group	$131 - $196	451%
Aetna	$132 - $199	454%
Cigna	$140 - $242	482%
Networks By Design	$142 - $213	489%
Molina Healthcare Of Ca	$153 - $229	526%
Multiplan	$164 - $245	564%
Central Health Plan	$174 - $262	599%
Dignity Health	$185 - $278	637%
Galaxy Health	$185 - $278	637%
Prime Health Services	$185 - $278	637%
Vantage Medical Group	$185 - $278	637%
Health Management Network	$196 - $294	674%
UnitedHealthcare	$206 - $417	709%
Blue Shield Of California	$268 - $412	922%
Blue Cross Blue Shield	$336 - $447	1156%

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 $123.
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 Loma Linda University 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.