CMS Price Transparency Data

Physical therapy (gait training)

Facility: Desert Valley Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $31
Cash Discount Price: $30
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Desert Valley Hospital is $31. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $30. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.07x the Medicare baseline. Located in 16850 Bear Valley Rd, Victorville, CA.

Cash / Self-Pay

$30

Average discount available for prompt cash payment at this facility.

Insurance Median

$31

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: $30 (103%)

Insurance Median: $31 (107%)

Cash: $30 (103% of Medicare)

Ins. Median: $31 (107% 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
Blue Shield Of Promise	$16 - $31	55%
Heritage Victor Valley Medical Group	$16 - $40	55%
High Desert Pace	$16 - $31	55%
Molina	$16 - $31	55%
Traditional Medi-Cal	$16	55%
Vantage Care	$16 - $31	55%
Health Net Of Ca	$17 - $46	58%
Inland Empire Health Plan	$23 - $38	79%
Blue Shield Of Ca	$30 - $49	103%
Aetna	$31 - $39	107%
Alignment	$31	107%
Blue Cross Blue Shield	$31 - $271	107%
Brand New Day	$31 - $46	107%
Choice Physicians Network	$31	107%
Elite Health Plan	$31	107%
Epic Health Plan	$31	107%
High Desert Primary Care	$31	107%
Inland Empire Foundation For Medical Care	$31	107%
Medicare (plans)	$31	107%
Renal Payor Solutions	$31	107%
The Geo Group Inc	$31	107%
Tricare	$31	107%
UnitedHealthcare	$31	107%
Imperial Health Plan Of Ca	$32	110%
Wellpath	$37	127%
Prime Health Services Inc	$39	134%
Workers Compensation	$40	138%
Employer Direct Healthcare	$43	148%
Naphcare	$43	148%

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 $30.
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 Desert Valley Hospital 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.