CMS Price Transparency Data

Physical therapy (gait training)

Facility: Shriners Hospitals for Children Northern Calif

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $35
Cash Discount Price: $169
vs. Medicare Baseline: 1.20x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Shriners Hospitals for Children Northern Calif is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $169. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.20x the Medicare baseline. Located in 2425 Stockton Boulevard, Sacramento, CA.

Cash / Self-Pay

$169

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $169 (582%)

Insurance Median: $35 (120%)

Cash: $169 (582% of Medicare)

Ins. Median: $35 (120% 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
Aetna	$28 - $30	96%
Ambetter / Centene	$28 - $35	96%
Molina Healthcare Of Ms	$28	96%
Northbay Healthcare	$30	103%
Amerihealth Caritas Nc	$32	110%
Amerihealth Caritas Sc	$32	110%
Caresource Of Oh	$32	110%
Sutter Medical Foundation	$34	117%
Health Net Of Ca	$35	120%
Sana Benefits	$39 - $43	134%
Kaiser Permanente	$100	344%
Blue Cross Blue Shield	$113 - $307	389%
Cigna	$130	447%
Providence Health Plan	$139	478%
UnitedHealthcare	$167 - $180	575%
Dignity Health	$233	802%

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 $169.
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 Shriners Hospitals for Children Northern Calif 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.