CMS Price Transparency Data

Physical therapy (gait training)

Facility: Community Memorial Hospital - Ventura

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $32
Cash Discount Price: $172
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Community Memorial Hospital - Ventura is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $172. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.10x the Medicare baseline. Located in 147 North Brent Street, Ventura, CA.

Cash / Self-Pay

$172

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: $172 (592%)

Insurance Median: $32 (110%)

Cash: $172 (592% 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

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
Medi-Cal	$13	45%
Non Contracted	$13 - $32	45%
Gold Coast Health Plan	$19 - $100	65%
Medicaid / KanCare	$19 - $100	65%
Aetna	$23 - $162	79%
Alignment Health Plan	$32	110%
Blue Cross Blue Shield	$32 - $43	110%
California Workers Compensation	$32	110%
Humana	$32	110%
Medicare (plans)	$32	110%
Scan Health Plan	$32	110%
Seaview	$32	110%
Tricare	$32	110%
UnitedHealthcare	$32 - $420	110%
Wellcare Of California	$32	110%
Valley Care	$41 - $72	141%
Ventura County Health Care Plan	$72	248%
Multiplan	$172	592%
Health Net Commercial	$286	984%
Cigna	$290	998%
Kaiser Commercial	$528	1817%
Blue Shield Epn	$578	1989%
Blue Shield Commercial	$626	2154%

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 $172.
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 Community Memorial Hospital - Ventura 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.