CMS Price Transparency Data

Physical therapy (gait training)

Facility: Adventist Health Delano

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $45
Cash Discount Price: $16
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Adventist Health Delano is $45. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $16. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.55x the Medicare baseline. Located in 1401 Garces Highway, Delano, CA.

Cash / Self-Pay

$16

Average discount available for prompt cash payment at this facility.

Insurance Median

$45

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: $16 (55%)

Insurance Median: $45 (155%)

Cash: $16 (55% of Medicare)

Ins. Median: $45 (155% 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
Dignty Hlth Mcal Op Only	$16	55%
Kaiser Medi-Cal Ip/Op Only	$16	55%
Medi-Cal	$16	55%
Universal Care Mcal	$16	55%
Blue Shield Epn - All Other Plans	$18	62%
Blue Cross Blue Shield	$19 - $67	65%
Healthnet Medi-Cal	$19	65%
Kern Health System Mcal	$21	72%
Bakersfield Fam Med Grp-All Plans	$31	107%
Healthnet Mcr Adv	$31	107%
Kern Mcr Adv Dual Dnsp-All Other Plans	$31	107%
Medicare (plans)	$31 - $49	107%
Tricare	$31	107%
UnitedHealthcare	$31 - $58	107%
Universal Care Mcr- All Other Plans	$31	107%
Healthnet- All Other Plans	$42	145%
Coventry- All Plans	$48	165%
Kaiser Comm Ip/Op Only- All Other Plans	$53	182%
Ah Employee Health Plan - All Plans	$55	189%
County Of Kern Network - All Plans	$56	193%
Gem Care- All Plans	$56	193%
Aetna	$59	203%
Foundation For Medical Care Of Kern County - All P	$60	206%
Cigna	$64	220%
Western Growers - All Plans	$65	224%
Centivo - All Plans	$69	237%
Blue Shield Non-Epn	$262	902%

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 $16.
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 Adventist Health Delano 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.