CMS Price Transparency Data

Physical therapy (gait training)

Facility: Adventist Health Clearlake

Billing Code: 97116 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$135

about 4.7× the $29 Medicare rate · typically $43–$352

modeled estimate · not a bill or quote

Medicare pays $29 Fair price $135 Cash price $79 Hospital's list price $220

How we calculate the fair BaseRate →

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$51 - $183	175%
Blue Cross Blue Shieldmajor	$46 - $543	158%
Aetnamajor	$164	564%
Cignamajor	$198	681%
Humanamajor	$187	643%
Kaiser Permanentemajor	$46 - $198	158%
Health Net	$180	619%
+ 6 smaller / regional plans	$16 - $363

Government programs also on file: Medicaid, Military & VA.

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 79), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97116.

Insurance Before you use insurance

Call your insurance company to confirm Adventist Health Clearlake is in-network.
Ask your insurer whether prior approval is required for CPT code 97116.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Adventist Health Clearlake

Compare: Physical therapy (gait training) at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.