CMS Price Transparency Data

Physical therapy (gait training)

Facility: Adventist Health Castle

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $89
Cash Discount Price: $45
vs. Medicare Baseline: 3.06x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Adventist Health Castle is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.06x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $45 (155%)

Insurance Median: $89 (306%)

Cash: $45 (155% of Medicare)

Ins. Median: $89 (306% 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 306% of the Medicare baseline (a markup of 206%). 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
UnitedHealthcare	$17	58%
Kfh Mcr Adv	$31	107%
Medicare (plans)	$31	107%
Ohana Health Plan - All Plans	$31	107%
Devoted Hlth Mcr Adv - All Plans	$32	110%
Hmsa Hmo	$34	117%
Hmsa Ppo - All Other Plans	$34	117%
Alohacare Quest Mcaid - All Other Plans	$35	120%
Pacific Admin Ppo - All Plans	$89	306%
Hwmg/Hmaa - All Plans	$103	354%
Health Alliance - All Plans	$112	385%
Mdx Hawaii Ppo - All Plans	$112	385%
Kfh - All Other Plans	$119	409%
Uni Health Alliance - All Plans	$131	451%
First Health Ppo - All Plans	$132	454%
Medicaid / KanCare	$140	482%
State Of Hi Nonprofit - All Plans	$245	843%

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 $45.
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 Castle 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.