CMS Price Transparency Data
Physical therapy (gait training)
Facility: Coastal Communities Hospital
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $33
- Cash Discount Price: $86
- vs. Medicare Baseline: 1.14x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Coastal Communities Hospital is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.14x the Medicare baseline. Located in 2701 S Bristol St, Santa Ana, CA.
Cash / Self-Pay
$86
Average discount available for prompt cash payment at this facility.
Insurance Median
$33
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: $86 (296%)
Insurance Median: $33 (114%)
Cash: $86 (296% of Medicare)
Ins. Median: $33 (114% 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
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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 |
|---|---|---|
| Kpc Healthcare Inc | $14 - $40 | 48% |
| Altamed Mcal Hmo (Ancillary) | $16 | 55% |
| Healthcare Partners | $16 | 55% |
| Hollywood Presbyterian | $16 - $32 | 55% |
| Kaiser | $16 - $53 | 55% |
| Medi-Cal Hmo/Non Contract | $16 | 55% |
| Medicaid / KanCare | $16 | 55% |
| Altamed Health Services | $23 - $32 | 79% |
| Caloptima | $23 - $32 | 79% |
| Choc Health Alliance | $23 | 79% |
| County Of Orange | $23 | 79% |
| Family Choice | $23 | 79% |
| Heritage Provider Network | $23 - $52 | 79% |
| Prospect Health Plan | $23 - $48 | 79% |
| Ihhi Reciprocity | $26 | 89% |
| Champus | $30 | 103% |
| Coventry Auto Network | $30 | 103% |
| Interplan | $30 - $64 | 103% |
| Prime Health Srvs/Wc | $30 | 103% |
| Coventry Wc | $31 | 107% |
| Blue Shield | $32 - $122 | 110% |
| Central Health Plan Of California | $32 | 110% |
| Champion Health Plan | $32 | 110% |
| Choice Physicians Network | $32 | 110% |
| Citizens Choice Health Plan | $32 | 110% |
| Clever Care Health Plan | $32 | 110% |
| Easy Choice Health Plan | $32 | 110% |
| For Your Benefit | $32 | 110% |
| Health Net | $32 - $63 | 110% |
| Healthcare Partners Sr Hmo | $32 | 110% |
| Heritage | $32 | 110% |
| Humana | $32 | 110% |
| Imperial Health Plan Of Ca | $32 | 110% |
| Innovative Integrated Health | $32 | 110% |
| Medcare Partners | $32 | 110% |
| Monarch | $32 - $167 | 110% |
| Onecare | $32 | 110% |
| Onecare Connect | $32 | 110% |
| Other Senior Non Contract | $32 | 110% |
| Scan Health Plan | $32 | 110% |
| Self Pay Ab774/Cbo Use Only | $32 | 110% |
| UnitedHealthcare | $32 - $220 | 110% |
| Us Dept Of Labor | $32 | 110% |
| Us Federal Marshall/Department Of Immigration | $32 | 110% |
| Velocity Provider Network Sr | $32 | 110% |
| Verda Health Plan Sr | $32 | 110% |
| Veterans Administration | $32 | 110% |
| Victim Of Violent Crime | $32 | 110% |
| Victoria Hospice | $32 | 110% |
| Multiplan | $33 - $60 | 114% |
| Three Rivers | $33 | 114% |
| Velocity National Provider Network Wc | $33 | 114% |
| Workers Comp State Of California | $33 | 114% |
| Brand New Day | $36 | 124% |
| Prime Health Srvs | $37 - $69 | 127% |
| County Of Orange/Custody/Advanced Medmgt | $40 | 138% |
| Veterans Evaluation Services | $40 | 138% |
| First Health | $45 | 155% |
| Staywell/Island Home Ins | $45 | 155% |
| Aetna | $52 | 179% |
| Magellan | $52 | 179% |
| Cigna | $56 - $315 | 193% |
| Three Rivers Network | $56 | 193% |
| Velocity National Provider Network Ppo | $56 | 193% |
| Networks By Design | $60 | 206% |
| Networks By Design Wc | $60 | 206% |
| Healthsmart | $64 | 220% |
| Prime Health | $64 | 220% |
| Pnoa-Provider Network Of America | $69 | 237% |
| Prime Health Srvs/Network | $73 | 251% |
| Lucet Behavioral Health Sr | $86 | 296% |
| Managed Health Network | $86 | 296% |
| Other Insurance Loa | $86 | 296% |
| Other Non Contracted Plans | $86 | 296% |
| Private Pay | $86 | 296% |
| Us Behavioral Health Plan | $86 | 296% |
| Vitas Hospice | $86 | 296% |
| Monarch Health Plan | $179 | 616% |