CMS Price Transparency Data

Physical therapy (gait training)

Facility: Adventist Health Twin Cities

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $280
Cash Discount Price: $26
vs. Medicare Baseline: 9.64x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Adventist Health Twin Cities is $280. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 9.64x the Medicare baseline. Located in 1100 Las Tablas Rd, Templeton, CA.

Cash / Self-Pay

$26

Average discount available for prompt cash payment at this facility.

Insurance Median

$280

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: $26 (89%)

Insurance Median: $280 (964%)

Cash: $26 (89% of Medicare)

Ins. Median: $280 (964% 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 964% of the Medicare baseline (a markup of 864%). 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
Aetna	$31 - $474	107%
Cencal Mcr Adv - All Other Plans	$31	107%
Tricare	$31	107%
UnitedHealthcare	$31 - $431	107%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$40	138%
Ah Employee Health Plan - All Plans	$56	193%
Hpn-Heritage Prov Ntwrk-All Plans	$98 - $154	337%
Chn-Community Hlth Ntwrk-All Plans	$158 - $249	544%
Nbd-Ntwrks By Design Exlus-All Other Plans	$166 - $261	571%
Nbd-Ntwrks By Design Non-Exlus	$166 - $261	571%
Blue Shield Epn	$244	840%
Pacific Health Alliance-All Plans	$258 - $407	888%
Blue Shield Hmo/Pos	$280	964%
Medi-Cal	$287 - $452	988%
Cencal Mcal	$327 - $515	1125%
Blue Shield Epo/Ppo - All Other Plans	$329	1132%
Blue Shield Promise Mcal	$345 - $543	1187%
Ccah-Centrl Ca Allince Mcal-All Plans	$373 - $588	1284%
Coalinga-All Plans	$373 - $588	1284%

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 $26.
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 Twin Cities 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.