CMS Price Transparency Data

Physical therapy (gait training)

Facility: Adventist Health Vallejo

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $226
Cash Discount Price: $58
vs. Medicare Baseline: 7.78x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Adventist Health Vallejo is $226. 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 7.78x the Medicare baseline. Located in 525 Oregon St, Vallejo, CA.

Cash / Self-Pay

$58

Average discount available for prompt cash payment at this facility.

Insurance Median

$226

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: $226 (778%)

Cash: $58 (200% of Medicare)

Ins. Median: $226 (778% 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 778% of the Medicare baseline (a markup of 678%). 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%
Va Medi-Cal	$16	55%
Blue Shield Mcr Adv	$30	103%
Medicare (plans)	$30	103%
Napa County Mcal Child	$30	103%
Tricare	$30	103%
UnitedHealthcare	$30 - $247	103%
Va Mcr-All Other Plans	$30	103%
Ah Employee Health Plan-All Plans	$54	186%
Aetna	$102	351%
Blue Shield Behav Hlth	$175	602%
Phcs-All Plans	$213	733%
Healthnet-All Plans	$238	819%
Interplan-All Plans	$252	867%
Choicecare-All Plans	$272	936%
Blue Shield Epn	$286	984%
Beech Street-All Plans	$291	1001%
Blue Shield Non-Epn-All Other Plans	$294	1012%
Western Growers-All Plans	$297	1022%
Cigna	$310	1067%
Kaiser-All Plans	$326	1122%
Health Management Network-All Plans	$330	1136%
Galaxy Network-All Plans	$349	1201%
Three Rivers-All Plans	$349	1201%
Blue Cross Blue Shield	$369 - $441	1270%

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 Adventist Health Vallejo 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.