CMS Price Transparency Data

Physical therapy (gait training)

Facility: HCA Florida Highlands Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97116
  • Insurance Median: $30
  • Cash Discount Price: $259
  • vs. Medicare Baseline: 1.03x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at HCA Florida Highlands Hospital is $30. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $259. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.03x the Medicare baseline. Located in 3600 S Highlands Ave, Sebring, FL.
Cash / Self-Pay
$259

Average discount available for prompt cash payment at this facility.

Insurance Median
$30

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: $259 (891%)
Insurance Median: $30 (103%)
Cash: $259 (891% of Medicare)
Ins. Median: $30 (103% 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
Freedom Health $22 76%
Devoted Health $25 - $29 86%
Humana $25 - $104 86%
Ndms Definitive Care $25 - $29 86%
United $25 - $117 86%
Wellmed $25 - $29 86%
Aetna $26 - $78 89%
Blue Cross Blue Shield $26 - $29 89%
Prominence Healthfirst $26 - $30 89%
Sunshine State $26 - $31 89%
American Health Plan $27 - $30 93%
Cigna $27 - $91 93%
Florida Complete Care $27 - $31 93%
Centurion $28 - $31 96%
Amerihealth Caritas $30 - $34 103%
Longevity Health Plan $30 - $34 103%
Prime Health $33 114%
Avmed $34 - $130 117%
Molina $49 169%
Oscar $49 169%
Simply Healthcare $61 210%
Office Of Sheiff Highland Co $91 313%
United Ppo $114 392%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3600 S Highlands Ave, Sebring, FL 33870
  • CMS Rating: ★★★☆☆
  • Ownership Type: Proprietary
  • Hospital Type: Acute Care Hospitals