CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mease Dunedin Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $80
Cash Discount Price: $91
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mease Dunedin Hospital is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $91. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.75x the Medicare baseline. Located in 601 Main St, Dunedin, FL.

Cash / Self-Pay

$91

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $91 (313%)

Insurance Median: $80 (275%)

Cash: $91 (313% of Medicare)

Ins. Median: $80 (275% 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 275% of the Medicare baseline (a markup of 175%). 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
Clear Health Alliance	$19	65%
UnitedHealthcare	$19 - $137	65%
Aetna	$20 - $124	69%
Freedom Health	$20	69%
Humana	$20 - $35	69%
Molina Healthcare	$20	69%
Simply Healthcare	$20 - $27	69%
Sunshine Health	$20	69%
Florida Community Care	$21	72%
Molina	$27 - $90	93%
Baycareplus	$28	96%
Blue Cross Blue Shield	$28 - $152	96%
Freedom	$30	103%
Optimum	$30	103%
Solis Health	$30	103%
Cigna	$32 - $152	110%
Careplus	$35	120%
Wellcare	$39	134%
Ultimate Health Plan	$46	158%
Avmed	$47 - $109	162%
Ambetter / Centene	$62 - $152	213%
Evolutions	$76 - $141	262%
First Health	$129	444%
Multiplan	$137	471%
United Behavioral Health	$152	523%

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 $91.
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 Mease Dunedin 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.