CMS Price Transparency Data

Physical therapy (gait training)

Facility: Alta Vista Regional Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $174
Cash Discount Price: $155
vs. Medicare Baseline: 5.99x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Alta Vista Regional Hospital is $174. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.99x the Medicare baseline. Located in 104 Legion Drive, Las Vegas, NM.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$174

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: $155 (533%)

Insurance Median: $174 (599%)

Cash: $155 (533% of Medicare)

Ins. Median: $174 (599% 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 599% of the Medicare baseline (a markup of 499%). 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
Commercial Hmo Ppo	$24 - $310	83%
Medicaid / KanCare	$25 - $310	86%
Php Centennial	$25	86%
Champus	$29 - $310	100%
Medicare (plans)	$31 - $310	107%
UnitedHealthcare	$43 - $50	148%
Mcare Mcaid Hmo Dual	$50	172%
Workers Comp	$127 - $310	437%
Self Pay	$155	533%
Other Covernment	$194 - $310	668%
Blue Cross Blue Shield	$232 - $310	798%
Mva	$310	1067%
Other Government	$310	1067%

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 $155.
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 Alta Vista Regional Hospital 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.