CMS Price Transparency Data
Physical therapy (gait training)
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $32
- Cash Discount Price: $68
- vs. Medicare Baseline: 1.10x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Saint Alphonsus Medical Center Ontario is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.10x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$68
Average discount available for prompt cash payment at this facility.
Insurance Median
$32
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: $68 (234%)
Insurance Median: $32 (110%)
Cash: $68 (234% of Medicare)
Ins. Median: $32 (110% 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.
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 |
|---|---|---|
| Medicaid / KanCare | $18 - $32 | 62% |
| Blue Cross Blue Shield | $28 - $89 | 96% |
| Medicare (plans) | $28 - $30 | 96% |
| UnitedHealthcare | $28 - $101 | 96% |
| Aetna | $29 - $99 | 100% |
| American Health Advantage Of Idaho | $30 | 103% |
| Ada County Jail Inmate Ins | $32 | 110% |
| Ambetter / Centene | $32 | 110% |
| Amish Mennonite | $32 | 110% |
| Bcccp-Michigan | $32 | 110% |
| Bccp | $32 | 110% |
| Bmc Healthnet | $32 | 110% |
| Breast Grant-Connecticut | $32 | 110% |
| California Health And Wellness | $32 | 110% |
| Cardinal Innovations Lme | $32 | 110% |
| Care Oregon Ohp | $32 | 110% |
| Cencal Health Plan | $32 | 110% |
| Cenpatico | $32 | 110% |
| Centurion Of Idaho | $32 | 110% |
| Chhuny | $32 | 110% |
| Childrens Comm Health Plan | $32 | 110% |
| Childrens Medical Services Title 19 | $32 | 110% |
| Cigna | $32 - $99 | 110% |
| Community Benefit Health | $32 | 110% |
| Community Care Behavorial Health | $32 | 110% |
| Community Health Choice | $32 | 110% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $32 | 110% |
| Dean Wi Badgercare | $32 | 110% |
| Delaware First Health | $32 | 110% |
| Delta Dental Nj | $32 | 110% |
| Dph Tb Program | $32 | 110% |
| Dscc | $32 | 110% |
| Eastpointe Lme | $32 | 110% |
| Family Health Network | $32 | 110% |
| Freedom First Healthcare | $32 | 110% |
| Ghc Scw Wi Badgercare | $32 | 110% |
| Harbor Health | $32 | 110% |
| Health Safety Net | $32 | 110% |
| Healthy Blue Ne | $32 | 110% |
| Hennepin Health | $32 | 110% |
| Humana | $32 - $92 | 110% |
| Id County Ada | $32 | 110% |
| Id County Canyon | $32 | 110% |
| Id County Cat Fund | $32 | 110% |
| Id County Payette | $32 | 110% |
| Idaho Womens Health Check | $32 | 110% |
| Indiana Breast Cervical Cancer | $32 | 110% |
| Inland Empire Health Plan | $32 | 110% |
| Intercommunity Health Ohp | $32 | 110% |
| Iowa Total Care | $32 | 110% |
| Jai Medical System | $32 | 110% |
| Kern Family Health Plan | $32 | 110% |
| Keystone First | $32 | 110% |
| Keystone First Chip | $32 | 110% |
| La Care Health Plan | $32 | 110% |
| Lakeland Care Inc | $32 | 110% |
| Managed Health Services - Indiana | $32 | 110% |
| Maryland Breast & Cervical Program | $32 | 110% |
| Maryland Healthy Smiles - Scion Dental | $32 | 110% |
| Maryland Physicians Care | $32 | 110% |
| Massachusetts Behavioral Health Partnership | $32 | 110% |
| Mdwise | $32 | 110% |
| Medi-Cal | $32 | 110% |
| Medi-Cal Healthnet | $32 | 110% |
| Medstar Dc Healthy Family | $32 | 110% |
| Medstar Md Health Choice | $32 | 110% |
| Mo Home State Health Plan | $32 | 110% |
| Molina Centennial Care | $32 | 110% |
| Nascentia Health Options | $32 | 110% |
| Nebraska Total Care | $32 | 110% |
| New York Cancer Services Program | $32 | 110% |
| Nextlevel Health | $32 | 110% |
| Oregon Screenwise | $32 | 110% |
| Pace Of Southwest Michigan | $32 | 110% |
| Paramount Advantage | $32 | 110% |
| Parkland Community Health Plan | $32 | 110% |
| Partners Behavioral Lme | $32 | 110% |
| Peach State Healthplan | $32 | 110% |
| Presbyterian Centennial Care | $32 | 110% |
| Prestige Health Choice | $32 | 110% |
| Priority Partners | $32 | 110% |
| Rx 340B Pass Along | $32 | 110% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $32 | 110% |
| Rx Medi-Cal | $32 | 110% |
| Rx Meridian Rx | $32 | 110% |
| Sandhills Center Lme | $32 | 110% |
| Screening For Life | $32 | 110% |
| Sunshine State Health Plan | $32 | 110% |
| Superior Health | $32 | 110% |
| Tenncare | $32 | 110% |
| Texas Children'S Health Plan | $32 | 110% |
| Trillium Community Ohp | $32 | 110% |
| Tufts Health Public Plans | $32 | 110% |
| Vaya Health Lme | $32 | 110% |
| Wellsense Health Plan | $32 | 110% |
| Wi Womens Wellness | $32 | 110% |
| Blue Benefit Administrators Of Massachusetts | $46 | 158% |
| Blue Care Network | $46 | 158% |
| Blue Distinction Transplant | $46 | 158% |
| Blue Shield - Ca | $46 | 158% |
| Blue Shield - Id (Regence) | $46 | 158% |
| Blue Shield - Ny Highmark Northeastern | $46 | 158% |
| Blue Shield - Ny Highmark Western | $46 | 158% |
| Blue Shield - Pa (Highmark) | $46 | 158% |
| Blue Shield - Wa (Regence) | $46 | 158% |
| Healthcare Management Admin | $49 | 169% |
| Selecthealth | $50 - $94 | 172% |
| Moda Health | $54 - $102 | 186% |
| Mountain Health Co-Op | $63 | 217% |
| Pacificsource Health Plans | $63 - $99 | 217% |
| Webtpa | $77 - $94 | 265% |
| Allegiance | $80 | 275% |
| Correctional Health Partners | $82 | 282% |
| Columbia Health Network | $84 | 289% |
| Healthnet | $88 | 303% |
| Allied National Global Care | $94 | 323% |
| Asrm - Reliance Standard Life Insurance | $94 | 323% |
| Christian Care Ministry | $94 | 323% |
| Dean Health | $94 | 323% |
| Fallon Health | $94 | 323% |
| Family Life Insurance Company | $94 | 323% |
| First Choice Health | $94 | 323% |
| Ghc Scw | $94 | 323% |
| International Benefit Administrators | $94 | 323% |
| Lifetime Benefit Solutions | $94 | 323% |
| Manhattan Life | $94 | 323% |
| Pai | $94 | 323% |
| Pan-American Life | $94 | 323% |
| Paramount Hmo | $94 | 323% |
| Phcs | $94 | 323% |
| Trinity Health Share | $94 | 323% |
| Lifewise | $98 | 337% |
| Allied Benefit Systems | $99 | 341% |
| Ameriben | $99 | 341% |
| Asr Health Benefits | $99 | 341% |
| Christian Brother Services | $99 | 341% |
| Geha | $99 - $101 | 341% |
| Healthez | $99 | 341% |
| Luminare Health (Detroit) | $99 | 341% |
| Priority Health | $99 | 341% |
| Rural Carrier Health Benefit Plan | $99 | 341% |
| First Health | $100 | 344% |
| Medi Share | $100 | 344% |
| Providence | $100 | 344% |