CMS Price Transparency Data
Physical therapy (gait training)
Facility: Watsonville Community Hospital
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $197
- Cash Discount Price: $197
- vs. Medicare Baseline: 6.78x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Watsonville Community Hospital is $197. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $197. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 6.78x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.
Cash / Self-Pay
$197
Average discount available for prompt cash payment at this facility.
Insurance Median
$197
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: $197 (678%)
Insurance Median: $197 (678%)
Cash: $197 (678% of Medicare)
Ins. Median: $197 (678% 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 678% of the Medicare baseline (a markup of 578%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Healthy Families | $14 - $17 | 48% |
| Medi-Cal E.R. | $14 - $17 | 48% |
| California Childrens Srvs | $14 - $17 | 48% |
| Ccs/Monterey County | $14 - $17 | 48% |
| Medicaid / KanCare | $14 - $17 | 48% |
| Medi-Cal/Eds | $14 - $17 | 48% |
| Well Path | $14 - $329 | 48% |
| Alliance/Sccho | $17 - $28 | 58% |
| U.S. Dept. of Labor | $32 | 110% |
| Hartford Workers' Comp | $32 | 110% |
| Western Growers Work Comp | $32 | 110% |
| Secure Horizons | $32 | 110% |
| Health Net of California | $32 - $206 | 110% |
| Alignment Health Plan | $32 | 110% |
| Medicare (plans) | $32 | 110% |
| Liberty Mutual Work Comp | $32 | 110% |
| Republic Idemnity W/Comp | $32 | 110% |
| Tricare | $32 | 110% |
| Keenan & Assoc Work Comp | $32 | 110% |
| Gallagher Bassett Svcs | $32 | 110% |
| UnitedHealthcare | $32 - $197 | 110% |
| Secure Horizons Dign HMO | $32 - $66 | 110% |
| Travelers Insurance | $32 - $329 | 110% |
| Ace-Usa | $32 | 110% |
| Fireman's Fund Work Comp | $32 | 110% |
| Beta Healthcare Group | $32 | 110% |
| Blue Shield PPO | $32 | 110% |
| Veterans Administration | $32 | 110% |
| Crawford & Co | $32 | 110% |
| Kemper Group Workers Comp | $32 | 110% |
| Miscellaneous Work Comp | $32 | 110% |
| Pinnacle Healthcare Uc | $32 | 110% |
| Workers Comp | $32 | 110% |
| Fleming & Associates | $32 | 110% |
| Medicruz | $59 | 203% |
| Victim Compensation Plan | $59 - $329 | 203% |
| Health Net Pmg HMO | $66 - $206 | 227% |
| Blue Shield HMO | $66 | 227% |
| Pacificare HMO | $66 - $197 | 227% |
| Great-West/Phcs | $66 - $230 | 227% |
| Aetna | $66 - $270 | 227% |
| Cigna | $66 - $230 | 227% |
| Blue Cross Blue Shield | $66 - $293 | 227% |
| Kaiser Northern | $104 | 358% |
| Western Growers Trust/Bc | $132 - $293 | 454% |
| Pinnacle Claims Tpa/Bc | $132 - $293 | 454% |
| Western Health Advantage | $164 | 564% |
| Self Pay | $197 | 678% |
| Pacificare PPO | $197 | 678% |
| Health Net Smartcare Netw | $197 | 678% |
| Health Net Blue and Gold | $206 | 709% |
| Health Net Canopycare HMO | $206 | 709% |
| Geha (Ccn) | $230 - $263 | 791% |
| First Health | $230 - $263 | 791% |
| Adventist Risk Management | $230 - $263 | 791% |
| Transwestern | $230 - $263 | 791% |
| Private Healthcare System | $256 | 881% |
| Multiplan Inc PPO | $256 | 881% |
| Salinas Valley Mem Hops | $279 | 960% |
| Coastal Healthcare Admin | $279 - $296 | 960% |
| Claims Management Wc | $285 - $293 | 981% |
| Monterey Bay Pub Emp Trst | $285 - $293 | 981% |
| Robert Kennedy/Ccn | $285 - $293 | 981% |
| Sheet Metal Workers | $285 - $293 | 981% |
| Laborers Health & Welfare | $285 - $293 | 981% |
| Carpenters H&W Trust | $285 - $293 | 981% |
| Calif Ironworkers Field | $285 - $293 | 981% |
| Operating Engineers | $285 - $293 | 981% |
| City of Wats/Pinnacle Clm | $285 - $293 | 981% |
| State Compensation Fund | $285 - $293 | 981% |
| Delta Health Systems | $285 - $293 | 981% |
| Teamsters Benefit Trust | $285 - $293 | 981% |
| Bankers Life & Casualty | $329 | 1132% |
| Aarp | $329 | 1132% |
| Physicians Mutual | $329 | 1132% |
| North Calif Bakery Driver | $329 | 1132% |
| Miscellaneous Insurance | $329 | 1132% |
| Apwu Health Plan | $329 | 1132% |
| Wholesale Beer Distributo | $329 | 1132% |
| Prucare Pmg POS | $329 | 1132% |
| Aaa | $329 | 1132% |
| Allstate | $329 | 1132% |
| Humana | $329 | 1132% |
| Miscellaneous Auto | $329 | 1132% |
| United Administrative | $329 | 1132% |
| Sutter Health Plus | $329 | 1132% |
| Zenith National Ins | $329 | 1132% |
| Farmers Insurance | $329 | 1132% |
| State Farm Ins | $329 | 1132% |
| Prucare Pmg HMO | $329 | 1132% |