CMS Price Transparency Data

Physical therapy (gait training)

Facility: Los Robles Hospital & Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $32
Cash Discount Price: $309
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Los Robles Hospital & Medical Center is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $309. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.10x the Medicare baseline. Located in 215 W Janss Rd, Thousand Oaks, CA.

Cash / Self-Pay

$309

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: $309 (1063%)

Insurance Median: $32 (110%)

Cash: $309 (1063% 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
Brand New Day	$14 - $32	48%
Gold Coast Health Plan	$14	48%
Aetna	$28 - $309	96%
Alignment Health Plan	$28 - $32	96%
Blue Cross Blue Shield	$28 - $32	96%
Central Health Plan	$28 - $32	96%
Clever Care Of Golden State	$28 - $32	96%
Easy Choice Health Plan	$28 - $32	96%
Facey Medical Group	$28 - $41	96%
Humana	$28 - $32	96%
La Care	$28 - $32	96%
Scan Health Plan	$28 - $32	96%
Triwest Healthcare Alliance	$28 - $32	96%
United	$28 - $87	96%
Blue Shield	$29 - $195	100%
Care1St Health Plan	$29 - $32	100%
Health Net	$32 - $126	110%
Corvel Corporation	$33 - $37	114%
Ventura County Foundation	$33 - $278	114%
Medcare Partners	$46	158%
Bright Health	$85	292%
First Health	$210 - $248	723%
Choicecare Network	$217	747%
Multiplan	$248 - $294	853%
Ppo Next	$248	853%
Interplan Corporation	$278	957%

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 $309.
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 Los Robles Hospital & 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.