CMS Price Transparency Data

Physical therapy (gait training)

Facility: Adventist Health Tulare

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $83
Cash Discount Price: $37
vs. Medicare Baseline: 2.86x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Adventist Health Tulare is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $37. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.86x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$37

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $37 (127%)

Insurance Median: $83 (286%)

Cash: $37 (127% of Medicare)

Ins. Median: $83 (286% 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 286% of the Medicare baseline (a markup of 186%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Medi-Cal	$16	55%
Dignity Mcal Op Only	$18	62%
Independence Op Only - All Plans	$18	62%
Blue Cross Blue Shield	$19 - $410	65%
Ccipa Medi-Cal - All Plans	$21	72%
Healthnet Medi-Cal	$21	72%
Blue Shield Mcare	$30	103%
Dignity Mcr Op Only - All Other Plans	$30	103%
Fhcn Pace Mcr Adv - All Plans	$30	103%
Medicare (plans)	$30	103%
Prime Health - All Plans	$30	103%
Tricare	$30	103%
UnitedHealthcare	$30 - $602	103%
Prison Hlthcre - All Plans	$39	134%
Cal Forensic Med Grp - All Plans	$40	138%
Bright Health - All Plans	$44	151%
Ah Employee Health Plan - All Plans	$55	189%
Incentive Hlth - All Plans	$55	189%
Healthnet Hmo/Ppo - All Other Plans	$81	279%
Cigna	$85 - $97	292%
Western Growers - All Plans	$86 - $99	296%
Network By Design-All Plans	$120 - $136	413%
Hs Interplan-All Plans	$123 - $141	423%
Aetna	$125	430%
Multiplan - All Plans	$156 - $178	537%
Blue Shield Epn	$256	881%
Blue Shield-All Other Plans	$356	1225%

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 $37.
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 Adventist Health Tulare 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.