CMS Price Transparency Data

Physical therapy (gait training)

Facility: Modoc Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $53
Cash Discount Price: $58
vs. Medicare Baseline: 1.82x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Modoc Medical Center is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $58. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.82x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$58

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $58 (200%)

Insurance Median: $53 (182%)

Cash: $58 (200% of Medicare)

Ins. Median: $53 (182% 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
Adv Med Mgmt - All Plans	$16	55%
Medi-Cal	$16	55%
Medi-Cal 7/1/24	$16	55%
Multiplan Wc	$29	100%
Integrated Hp Wc	$30	103%
Ntwrks By Design Wc - All Plans	$30	103%
Blue Shield Mcr Adv	$31	107%
Blue Shield Va	$31	107%
UnitedHealthcare	$31 - $55	107%
Healthnet Mcr Adv	$33	114%
Tricare	$33	114%
Blue Cross Blue Shield	$48 - $53	165%
Blue Shield Exch	$48	165%
Blue Shield Comm - All Other Plans	$53	182%
Carelon - All Plans	$53	182%
Corvel - All Plans	$54	186%
Aetna	$55	189%
Coventry/First Health - All Plans	$55	189%
Galaxy Health - All Plans	$55	189%
Healthnet Comm - All Other Plans	$55	189%
Hmn - All Plans	$55	189%
Integrated Hp - All Other Plans	$55	189%
Interplan - All Plans	$55	189%
Multiplan - All Other Plans	$55	189%
Superior Ca Ppo - All Plans	$55	189%
Partnership Hp - All Plans	$57	196%

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 $58.
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 Modoc Medical Center 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.