CMS Price Transparency Data
Physical therapy (gait training)
Facility: Menifee Global Medical Center
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $32
- Cash Discount Price: $167
- vs. Medicare Baseline: 1.10x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Menifee Global Medical Center is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $167. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.10x the Medicare baseline. Located in 28400 McCall Boulevard, Sun City, CA.
Cash / Self-Pay
$167
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: $167 (575%)
Insurance Median: $32 (110%)
Cash: $167 (575% 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.
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 |
|---|---|---|
| Lasalle Medical Assoc (Ancillary) Mcal Hmo | $13 | 45% |
| Health Net Medi-Cal | $16 | 55% |
| Ic | $16 - $167 | 55% |
| Kaiser Medi-Cal | $16 | 55% |
| Blue Cross Blue Shield | $17 | 58% |
| Prospect Health Plan Mcal Hmo | $17 | 58% |
| Molina Medi-Cal | $19 | 65% |
| Altamed Mcal Hmo | $23 | 79% |
| Altamed Mcal/Pace | $23 | 79% |
| Hpn Mcal | $23 | 79% |
| Iehp Medi-Cal | $24 | 83% |
| Tricare | $26 - $28 | 89% |
| Coventry | $30 - $31 | 103% |
| Prime Health Services Wcomp | $30 | 103% |
| Aetna | $31 - $213 | 107% |
| Altamed Comm Hmo (Ancillary) | $31 - $167 | 107% |
| Altamed Health Services Senior | $31 | 107% |
| Altamed Sr/Pace | $31 | 107% |
| Blue Shield Senior | $31 | 107% |
| Central Health Plan Senior | $31 | 107% |
| Clever Care Health Plan Sr | $31 | 107% |
| For Your Benefit Senior | $31 | 107% |
| Guidant Health Plan Senior | $31 | 107% |
| Health Net Senior | $31 | 107% |
| Hpn Senior | $31 | 107% |
| Humana | $31 | 107% |
| Imperial Health Plan Of Ca | $31 | 107% |
| Kaiser Senior | $31 | 107% |
| Lasalle Medical Assoc (Ancillary) Commercial | $31 | 107% |
| Lasalle Medical Assoc (Ancillary) Senior | $31 | 107% |
| Managed Health Network Sr | $31 | 107% |
| Medicare (plans) | $31 | 107% |
| Neighborhood Healthcare Pace | $31 | 107% |
| Point Comfort Underwriters | $31 | 107% |
| Primecare Senior | $31 | 107% |
| Prospect Health Plan Sr Hmo | $31 | 107% |
| Scan Senior | $31 | 107% |
| Self Pay/Ab774/Charity Discount | $31 | 107% |
| Sr Capitation | $31 | 107% |
| UnitedHealthcare | $31 - $117 | 107% |
| Veterans Administration | $31 | 107% |
| Three Rivers Wcomp | $33 | 114% |
| Workers Comp Non-Contracted | $33 | 114% |
| Align Senior Care | $34 | 117% |
| Welbehealth Sr/Pace | $34 | 117% |
| Prime Health Services Senior | $35 | 120% |
| Iehp Covered Ca | $38 | 131% |
| Molina Covered Ca | $40 | 138% |
| Prospect Health Plan Comm Hmo | $41 | 141% |
| Health Net Enhanced Ppo | $43 | 148% |
| Hpn Commercial/Covered Ca | $43 | 148% |
| Health Net Comm | $46 | 158% |
| Three Rivers Network | $54 | 186% |
| Velocity | $54 - $75 | 186% |
| Blue Shield Epn | $86 | 296% |
| First Health Commercial | $88 | 303% |
| Blue Shield Commercial | $101 | 348% |
| Primecare Commercial | $109 | 375% |
| Multiplan Ppo | $117 | 403% |
| Multiplan Wcomp | $117 | 403% |
| Cigna | $134 - $315 | 461% |
| Pnoa-Provider Network Of America | $134 | 461% |
| Prime Health Services Commercial | $134 | 461% |
| Ava Hospice | $167 | 575% |
| Kaiser Commercial | $167 | 575% |
| Living Waters Hospice | $167 | 575% |
| Managed Health Network | $167 | 575% |
| Other Insurance Loa | $167 | 575% |
| Pacific Valley Hospice | $167 | 575% |
| Private Pay | $167 | 575% |
| Silverado Hospice | $167 | 575% |
| Vna Hospice | $167 | 575% |
| Choice Physicians Network | $175 | 602% |