CMS Price Transparency Data

Physical therapy (gait training)

Facility: Sarasota Memorial Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $45
Cash Discount Price: $73
vs. Medicare Baseline: 1.55x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Sarasota Memorial Hospital is $45. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.55x the Medicare baseline. Located in 1700 S Tamiami Trl, Sarasota, FL.

Cash / Self-Pay

$73

Average discount available for prompt cash payment at this facility.

Insurance Median

$45

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: $73 (251%)

Insurance Median: $45 (155%)

Cash: $73 (251% of Medicare)

Ins. Median: $45 (155% 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.

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
Simply Healthcare	$19 - $20	65%
Molina	$20	69%
Sunshine State	$20	69%
Amerihealth Caritas	$21	72%
Community Care Plan	$21	72%
Florida Community Care	$21 - $31	72%
UnitedHealthcare	$26 - $145	89%
Blue Cross Blue Shield	$28 - $48	96%
Aetna	$29 - $154	100%
Simply Freedom Optimum	$30	103%
Wellcare	$30	103%
Wellcare Oncology	$30	103%
Simply Freedom Optimum Oncology	$31	107%
Florida Community Care Oncology	$35	120%
Oscar Oncology	$48	165%
Ambetter / Centene	$76	262%
Avmed	$127 - $141	437%
Usa Managed Care	$139 - $154	478%
First Health	$144 - $160	496%

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 $73.
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 Sarasota Memorial 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.