CMS Price Transparency Data
Physical therapy (gait training)
Facility: Children's Hosp of Los Angeles
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $40
- Cash Discount Price: $58
- vs. Medicare Baseline: 1.38x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Children's Hosp of Los Angeles is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $58. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.38x the Medicare baseline. Located in 4650 Sunset Blvd, Ms 108, Los Angeles, CA.
Cash / Self-Pay
$58
Average discount available for prompt cash payment at this facility.
Insurance Median
$40
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: $58 (200%)
Insurance Median: $40 (138%)
Cash: $58 (200% of Medicare)
Ins. Median: $40 (138% 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
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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 |
|---|---|---|
| Care 1St | $3 - $86 | 10% |
| La Care | $3 - $86 | 10% |
| Superior Choice Medical Group | $3 - $248 | 10% |
| El Proyecto Del Barrio | $3 - $108 | 10% |
| White Memorial Medical Center | $3 - $86 | 10% |
| Molina | $3 - $34 | 10% |
| Hollywood Presbyterian Medical Center | $3 - $86 | 10% |
| Noble Community Medical Associates | $3 - $178 | 10% |
| Intl - Quality Health Management | $3 - $69 | 10% |
| Family Care Specialists | $3 - $455 | 10% |
| Blue Shield | $3 - $86 | 10% |
| Asian Community Medical Group | $3 - $208 | 10% |
| St Francis Medical Center | $3 - $86 | 10% |
| Medi-Cal | $3 - $13 | 10% |
| Gold Coast Health Plan | $3 - $86 | 10% |
| Premier Physicians Ntwk | $3 - $108 | 10% |
| Valley Presbyterian Hospital | $3 - $86 | 10% |
| Preferred IPA | $3 - $86 | 10% |
| Heritage Provider Network | $3 - $86 | 10% |
| Altamed | $3 - $86 | 10% |
| Serendib Healthways Mmc | $3 - $150 | 10% |
| Crown City Medical Group | $3 - $86 | 10% |
| Champus | $3 - $31 | 10% |
| Community Family Care IPA | $3 - $86 | 10% |
| Kern Family Health Plan | $3 - $86 | 10% |
| Health Net | $3 - $108 | 10% |
| Healthy New Life Medical Corp | $3 - $208 | 10% |
| Souther California Hosp System - Mmc | $3 - $86 | 10% |
| Karing Physicians Medical Group | $3 - $178 | 10% |
| Accountable Health | $3 - $142 | 10% |
| Medicare (plans) | $3 - $32 | 10% |
| Allied Pacific IPA | $3 - $86 | 10% |
| Mabuhay Medical Group | $3 - $166 | 10% |
| Hispanic Physician IPA | $3 - $86 | 10% |
| Avalon IPA | $3 - $166 | 10% |
| Exceptional Care Medical Group | $3 - $536 | 10% |
| Watts Healthcare Mmc | $3 - $108 | 10% |
| Southern Atlantic Medical Group Mmc | $3 - $86 | 10% |
| Family Health Alliance Med Grp | $3 - $174 | 10% |
| Employee Health Systems Med Grp | $3 - $86 | 10% |
| Cal Care IPA | $3 - $86 | 10% |
| Angeles IPA | $3 - $86 | 10% |
| Intl - Aixin Life Insurance Co | $3 - $69 | 10% |
| Global Care Medical Group | $3 - $108 | 10% |
| Associated Hispanic Physicians IPA | $3 - $86 | 10% |
| Imperial Health Holdings Medical Group | $3 - $86 | 10% |
| Cencal Health | $3 - $86 | 10% |
| Pacific Alliance Medical Center | $3 - $86 | 10% |
| San Judas Med Grp | $3 - $86 | 10% |
| Choc Health Alliance | $3 - $20 | 10% |
| Community Care IPA Mmc | $3 - $167 | 10% |
| Medicaid / KanCare | $3 - $86 | 10% |
| Beverly Hospital | $3 - $86 | 10% |
| Primary Care and Pediatric IPA | $3 - $166 | 10% |
| UnitedHealthcare | $3 - $202 | 10% |
| Southland San Gabriel Valley Medical Group | $3 - $238 | 10% |
| Alhambra Hospital Medical Center | $3 - $86 | 10% |
| Centinela Valley IPA | $3 - $108 | 10% |
| Serra Community Med Clinic | $3 - $86 | 10% |
| Health Care La IPA | $3 - $108 | 10% |
| Blue Cross Blue Shield | $3 - $448 | 10% |
| Regent Medical Group | $3 - $178 | 10% |
| Inland Empire Health Plan | $3 - $33 | 10% |
| Dignity Health | $3 - $86 | 10% |
| Caloptima | $3 - $86 | 10% |
| Culinary Health Fund | $3 - $64 | 10% |
| Los Angeles Medical Center IPA | $3 - $86 | 10% |
| Bella Vista Med Grp | $3 - $108 | 10% |
| Adventist Health Physicians | $3 - $86 | 10% |
| Point Comfort Underwriters | $3 - $32 | 10% |
| Seaside Health Plan | $3 - $86 | 10% |
| California Pacific Physicians Medical Group | $3 - $208 | 10% |
| Applecare Medical Group | $3 - $519 | 10% |
| Intl - Global Excel Management | $4 - $64 | 14% |
| Shriners Hospital | $12 - $26 | 41% |
| Non-Contract Payors | $16 - $34 | 55% |
| Beech Street | $16 - $34 | 55% |
| Incentive Health Network | $16 - $34 | 55% |
| Emanate Health Medical Center Mmc | $18 - $39 | 62% |
| Kaiser | $19 - $49 | 65% |
| Axminster Medical Group | $19 - $100 | 65% |
| Cigna | $19 - $40 | 65% |
| Facey Medical Group | $19 - $100 | 65% |
| St. John's Health Clinic | $19 - $100 | 65% |
| Managed Care Systems | $20 - $43 | 69% |
| Accarent Health | $20 - $43 | 69% |
| Gemcare IPA | $20 - $43 | 69% |
| Mercy Care | $20 - $43 | 69% |
| Pioneer Prov Ntwk | $20 - $43 | 69% |
| Sansum Clinic | $20 - $43 | 69% |
| Staywell Insurance | $20 - $43 | 69% |
| Citrus Valley Phys Grp | $20 - $56 | 69% |
| Good Samaritan Medical Group | $21 - $46 | 72% |
| Book Md | $21 - $45 | 72% |
| Aetna | $21 - $47 | 72% |
| Choice Medical Group | $22 - $47 | 76% |
| Intl - Global Medical Management | $22 - $47 | 76% |
| National Healthcare Solutions | $22 - $47 | 76% |
| Community Care | $22 - $47 | 76% |
| Self-Pay | $24 - $52 | 83% |
| Ventura County Health Plan | $24 - $628 | 83% |
| Sanus Health | $24 - $52 | 83% |
| Emanate Health Medical Center Commercial | $24 - $52 | 83% |
| Preferred IPA - Commercial | $24 - $52 | 83% |
| Access Medical Group | $24 - $51 | 83% |
| Seoul Medical Group | $24 - $51 | 83% |
| Private Hlthcare System | $24 - $52 | 83% |
| Delta Health Systems | $24 - $52 | 83% |
| Bright Medical Associates | $24 - $52 | 83% |
| Sierra Health and Life Insurance Company | $25 - $54 | 86% |
| Intl - Concierge Healthcare Services | $26 - $56 | 89% |
| Intl - Erv Travel Services | $26 - $60 | 89% |
| Cedar Sinai Med Grp | $26 - $56 | 89% |
| Plotkin Health | $26 - $56 | 89% |
| Embassy - Saudi Arabia | $26 - $56 | 89% |
| Serra Community Med Clinic - Commercial | $26 - $56 | 89% |
| Intl - Msh China Enterprise Services | $26 - $56 | 89% |
| Axis Services International | $26 - $56 | 89% |
| Redlands Community Hospital | $26 - $56 | 89% |
| Star Healthcare Network Commercial | $26 - $56 | 89% |
| Prime Health Services | $26 - $56 | 89% |
| Marian Health Services | $26 - $56 | 89% |
| Calvo Selectcare | $26 - $56 | 89% |
| Lakewood Health Plan | $26 - $56 | 89% |
| Multiplan | $28 - $60 | 96% |
| Memorialcare Med Foundation | $28 - $60 | 96% |
| Primecare Medical Network | $28 - $60 | 96% |
| Beaver Medical Group | $28 - $60 | 96% |
| Korean American Med Grp | $28 - $60 | 96% |
| Embassy - Kuwait | $30 - $64 | 103% |
| Prospect Medical Group | $30 - $64 | 103% |
| Interlink Health Services | $30 - $64 | 103% |
| Self-Pay International | $32 - $69 | 110% |
| Embassy - All Others | $32 - $69 | 110% |
| Providence Health Network | $337 - $464 | 1160% |