CMS Price Transparency Data

Physical therapy (gait training)

Facility: Incline Village Community Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $111
Cash Discount Price: $123
vs. Medicare Baseline: 3.82x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Incline Village Community Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.82x the Medicare baseline. Located in 880 Alder Street, Incline Village, NV.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $123 (423%)

Insurance Median: $111 (382%)

Cash: $123 (423% of Medicare)

Ins. Median: $111 (382% 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 382% of the Medicare baseline (a markup of 282%). 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
Blue Cross Blue Shield	$11 - $111	38%
Medicare (plans)	$48	165%
Aetna	$108	372%
Prominence Healthfirst - All Plans	$108	372%
Admar Multiplan - All Plans	$111	382%
First Health - All Plans	$111	382%
Great West/One Health - All Plans	$111	382%
Hometown Hp - All Plans	$111	382%
Humana	$111	382%
Interplan - All Plans	$111	382%
Multiplan - All Plans	$111	382%
Phcs - All Plans	$111	382%
UnitedHealthcare	$111	382%
Cigna	$113	389%
Beech Street/Capp Care - All Plans	$117	403%
Healthnet - All Plans	$117	403%
Uhn - All Plans	$117	403%
Sierra Health - All Plans	$119	409%
Ca Hlth And Wellness - All Plans	$125	430%

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 $123.
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 Incline Village Community 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.