CMS Price Transparency Data
Physical therapy (gait training)
Facility: Whittier Hospital Medical Center
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $69
- Cash Discount Price: $33
- vs. Medicare Baseline: 2.37x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Whittier Hospital Medical Center is $69. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.37x the Medicare baseline. Located in 9080 Colima Rd, Whittier, CA.
Cash / Self-Pay
$33
Average discount available for prompt cash payment at this facility.
Insurance Median
$69
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: $33 (114%)
Insurance Median: $69 (237%)
Cash: $33 (114% of Medicare)
Ins. Median: $69 (237% 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 237% of the Medicare baseline (a markup of 137%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aids Healthcare Foundation | $9 - $32 | 31% |
| Allied Physicians | $9 - $48 | 31% |
| Blue Cross Blue Shield | $9 - $293 | 31% |
| Kaiser Foundation | $9 - $190 | 31% |
| Synermed | $9 - $32 | 31% |
| Ahmc Medi-Cal Reciprocity Agreement | $11 | 38% |
| Alta Med Health Network | $11 - $32 | 38% |
| Altamed Health Services Corporation | $11 | 38% |
| Beverly Hospital | $11 - $35 | 38% |
| Brand New Day | $11 - $39 | 38% |
| Emanate Health | $11 - $39 | 38% |
| Health Net | $11 - $162 | 38% |
| Healthy Way La | $11 | 38% |
| Heritage Provider Network | $11 - $43 | 38% |
| La Care Healthy Families/Healthy Kids | $11 | 38% |
| Non Contracted Medi-Cal | $11 | 38% |
| Physicians Healthways Medical Corporation | $11 | 38% |
| Prospect Health Plan | $11 - $51 | 38% |
| Avanti | $13 - $38 | 45% |
| Care First Health Plan | $13 | 45% |
| County Of Los Angeles Dept Of Health Services | $13 | 45% |
| Hollywood Presbyterian Adv Med Mcal | $13 | 45% |
| Hollywood Presbyterian Medpoint Mcal | $13 | 45% |
| La Care Health Plan | $13 - $149 | 45% |
| Medi Caid/ Medi Cal | $13 | 45% |
| Monarch Healthplan | $13 | 45% |
| Caloptima | $16 - $32 | 55% |
| Veterans Administration | $22 | 76% |
| Physician Healthways | $23 - $27 | 79% |
| Aetna | $27 - $197 | 93% |
| Applecare Medical Group | $30 | 103% |
| Alignment Health Plan | $32 | 110% |
| Alta Los Angeles Hospitals Inc | $32 | 110% |
| Apa/Aco Inc | $32 | 110% |
| Blue Shield Of California | $32 - $433 | 110% |
| Caremore | $32 | 110% |
| Central Health Plan | $32 | 110% |
| Cov19 Hrsa Uninsured Testing And Treatment Fund | $32 | 110% |
| Easy Choice Health Plan | $32 | 110% |
| Fmc Los Angeles County | $32 - $203 | 110% |
| Humana | $32 | 110% |
| Interplan Health Group | $32 | 110% |
| La Care Covered Direct | $32 | 110% |
| Medicare (plans) | $32 - $33 | 110% |
| Pacific Alliance Medical Center | $32 | 110% |
| Pacificare Of California | $32 | 110% |
| Private Pay | $32 | 110% |
| Scan Health Plan | $32 | 110% |
| Self-Pay | $32 | 110% |
| Tricare | $32 | 110% |
| Athens Administrators Ahmc Work Comp | $33 | 114% |
| Misc 1 | $33 | 114% |
| Molina Healthcare Of California | $33 | 114% |
| Multiplan Wc | $33 | 114% |
| San Miguel Health Plan | $35 | 120% |
| Chinatown Service Center Pace | $38 | 131% |
| Ahmc Health | $40 | 138% |
| Knox-Keene Act | $40 | 138% |
| Molina Medical Center | $40 - $106 | 138% |
| Capnet | $60 | 206% |
| Pacific Independent Physician Association | $60 | 206% |
| Edward Medical Group | $65 | 224% |
| Allied Physicians Ipa | $69 | 237% |
| Ahmc Reciprocity | $70 - $81 | 241% |
| Ahmc Reciprocity Agreement Senior/Commercial | $70 - $81 | 241% |
| Wear And Wood | $70 - $108 | 241% |
| Health Net Inc | $79 - $135 | 272% |
| Central Health Plan Of California | $94 - $108 | 323% |
| Davita Healthcare Partners | $94 | 323% |
| Healthnet | $96 - $234 | 330% |
| UnitedHealthcare | $112 - $267 | 385% |
| Prospect Medical | $129 - $149 | 444% |
| Care 1St Health Plan | $140 - $163 | 482% |
| New Horizon Medical Group Inc | $140 - $163 | 482% |
| Cost Containment | $152 - $176 | 523% |
| Universal Care | $152 - $190 | 523% |
| Asi/Flex | $164 - $190 | 564% |
| Us Comp Care | $164 - $190 | 564% |
| Value Healthplan Of California | $164 - $190 | 564% |
| Community Care Network | $176 - $203 | 606% |
| Coventry Health Care | $176 - $203 | 606% |
| Coventry Health Care National Network | $176 - $203 | 606% |
| Interplan Corporation | $176 - $203 | 606% |
| Managed Care Administrators | $176 - $203 | 606% |
| Prohealth | $176 - $203 | 606% |
| Multiplan | $199 - $230 | 685% |
| Cigna | $234 - $271 | 805% |
| Commercial Non Contract | $234 - $271 | 805% |
| Medi-Cal Sub Acute | $234 - $271 | 805% |
| One Legacy | $234 - $271 | 805% |
| Great-West Healthcare Of California | $2,500 | 8603% |