CMS Price Transparency Data

Physical therapy (gait training)

Facility: Adventist Health Tehachapi Valley

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $44
Cash Discount Price: $32
vs. Medicare Baseline: 1.51x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Adventist Health Tehachapi Valley is $44. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.51x the Medicare baseline. Located in 1100 Magellan, Tehachapi, CA.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$44

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: $32 (110%)

Insurance Median: $44 (151%)

Cash: $32 (110% of Medicare)

Ins. Median: $44 (151% 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
Medi-Cal	$11 - $16	38%
Universal Ipa Mcal Op/Profee Only	$11 - $16	38%
Kaiser Medi-Cal Ip/Op Only	$16	55%
Bc Mcal	$17	58%
Aetna	$19 - $94	65%
Healthnet Medi-Cal	$20	69%
Khs-Kern Hlth Systm Mcal	$21	72%
Healthnet Mcare	$23 - $44	79%
Medicare (plans)	$23 - $44	79%
Tricare	$23 - $44	79%
UnitedHealthcare	$23 - $115	79%
Universal Ipa Mcr Adv Op/Profee Only-All Other Pla	$23 - $44	79%
Network Providers- All Plans	$29 - $57	100%
Cigna	$30 - $183	103%
Ah Employee Health Plan - All Plans	$34 - $124	117%
Oscar Health Plan- All Plans	$35 - $49	120%
Blue Shield Epn- All Other Plans	$37 - $98	127%
Coventry- All Plans	$37 - $211	127%
Blue Shield Non-Epn	$39 - $171	134%
Kaiser Ip/Op Only- All Other Plans	$39 - $76	134%
Blue Cross Blue Shield	$41 - $142	141%
Western Grwrs/Pinnacle - All Plans	$42 - $98	145%
Healthnet- All Other Plans	$44 - $180	151%
Klhp-Kern Legacy Epo -All Other Plans	$44 - $55	151%
Centivo - All Plans	$46 - $100	158%

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 $32.
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 Tehachapi Valley 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.