CMS Price Transparency Data
Physical therapy (gait training)
Facility: Garfield Medical Center
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $210
- Cash Discount Price: $398
- vs. Medicare Baseline: 7.23x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Garfield Medical Center is $210. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $398. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 7.23x the Medicare baseline. Located in 525 N Garfield Ave, Monterey Park, CA.
Cash / Self-Pay
$398
Average discount available for prompt cash payment at this facility.
Insurance Median
$210
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: $398 (1370%)
Insurance Median: $210 (723%)
Cash: $398 (1370% of Medicare)
Ins. Median: $210 (723% 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 723% of the Medicare baseline (a markup of 623%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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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 |
|---|---|---|
| Allied Physicians | $9 - $48 | 31% |
| Blue Cross Blue Shield | $9 - $490 | 31% |
| Ahmc Healthcare Inc | $11 - $294 | 38% |
| Beverly Hospital | $11 - $35 | 38% |
| Brand New Day | $11 - $40 | 38% |
| Care 1St Mcl/Gar Cap Reciprocity | $11 | 38% |
| Community Health Plan | $11 | 38% |
| Emanate Health | $11 - $40 | 38% |
| Health Net | $11 - $532 | 38% |
| Healthy Way La | $11 | 38% |
| La Care Health Plan | $11 - $539 | 38% |
| Other Non-Contracting Medi-Cal | $11 | 38% |
| Aids Health Foundation | $13 - $32 | 45% |
| Avanti | $13 - $38 | 45% |
| Hollywood Presbyterian Advanced Med Mgmt Mcal | $13 | 45% |
| Hollywood Presbyterian Medpoint Mcal | $13 | 45% |
| State Of California Medi-Cal | $13 | 45% |
| Physician Healthways Medical Corporation | $15 | 52% |
| Caloptima Direct | $19 | 65% |
| Veterans Administration | $22 | 76% |
| Associated Hispanic Phys Of So Cal | $23 - $196 | 79% |
| Care First Health Plan | $23 - $98 | 79% |
| UnitedHealthcare | $23 - $588 | 79% |
| Aetna | $28 - $713 | 96% |
| Apa Aco Inc | $32 | 110% |
| Blue Shield | $32 - $438 | 110% |
| Blue Shield Of California | $32 - $490 | 110% |
| Central Health Plan | $32 - $392 | 110% |
| Cms | $32 | 110% |
| Cv-19 Hrsa Uninsured Testing And Tx | $32 | 110% |
| Easy Choice Health Plan | $32 | 110% |
| First Health Network | $32 - $686 | 110% |
| Humana | $32 | 110% |
| Interplan | $32 - $735 | 110% |
| La Care Covered Direct | $32 | 110% |
| Non-Contract Medi-Care | $32 | 110% |
| Pacific Alliance Medical Center Comm/Sr | $32 | 110% |
| Preferred Health Network | $32 | 110% |
| Scan Health Plan Sr Hmo | $32 | 110% |
| Self-Pay | $32 | 110% |
| Ucla Impact Dept Of Uncology | $32 | 110% |
| Alignment Health Plan | $33 | 114% |
| Athens Administrators | $33 | 114% |
| Molina Healthcare | $33 | 114% |
| Molina Healthcare Of California | $33 - $40 | 114% |
| Multiplan | $33 - $833 | 114% |
| Other Non-Contracted Workers Compensation | $33 | 114% |
| Inter Valley Health Plan | $34 | 117% |
| National Disaster Medical System | $35 | 120% |
| San Miguel Health Plan | $35 | 120% |
| Chinatown Service Center Pace | $38 | 131% |
| Ahmc Health Epo | $40 | 138% |
| Knox-Keene Act | $40 | 138% |
| Advantage Care Ipa | $45 - $980 | 155% |
| Physicians Healthways Medi-Cal | $45 - $980 | 155% |
| Physicians Healthways Medical Corporation | $45 - $980 | 155% |
| Employee Health Systems Mg | $46 - $196 | 158% |
| Health Net Comm/Hmo | $51 - $539 | 175% |
| Health Net Inc | $52 | 179% |
| Access Ipa Ancillary | $60 | 206% |
| Family Health Alliance | $60 | 206% |
| Pacific Independent Physician Association | $60 | 206% |
| Private Pay | $60 | 206% |
| Allied Physicians Risk Pool | $80 - $343 | 275% |
| Allied Physicians Risk Pool Agreement | $80 - $343 | 275% |
| Healthnet Medi Cal Cap | $80 - $343 | 275% |
| Pipa Risk Pool Agreement | $80 - $343 | 275% |
| Molina Medical Group | $90 - $382 | 310% |
| Health Net Foundation Comm/Sr (Family Health Alliance) | $92 - $392 | 317% |
| Health Net Foundation M Cal (Family Health Alliance) | $92 - $392 | 317% |
| Phys Assoc Of San Gab Valley | $92 - $392 | 317% |
| Allied Physicians Med Grp | $115 - $490 | 396% |
| Alhambra Hospital | $138 - $588 | 475% |
| Care 1St Health Plan | $138 - $588 | 475% |
| One Health Plan | $161 - $686 | 554% |
| Fmc Los Angeles Co Epo | $172 - $735 | 592% |
| Pacificare Ppo | $181 | 623% |
| Corvel Corporation | $184 - $784 | 633% |
| Americas Health Plan | $196 - $833 | 674% |
| Health Payors Organization | $207 - $882 | 712% |
| Cigna | $230 - $453 | 791% |
| East La Reg Ctr | $230 - $980 | 791% |
| Non Contract Commercial | $230 - $980 | 791% |
| One Legacy | $230 - $980 | 791% |
| Pacificare Of California Inc | $246 | 847% |