CMS Price Transparency Data
Physical therapy (gait training)
Facility: Palmetto General Hospital
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $56
- Cash Discount Price: $431
- vs. Medicare Baseline: 1.93x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Palmetto General Hospital is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $431. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.93x the Medicare baseline. Located in 2001 W 68Th St, Hialeah, FL.
Cash / Self-Pay
$431
Average discount available for prompt cash payment at this facility.
Insurance Median
$56
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: $431 (1483%)
Insurance Median: $56 (193%)
Cash: $431 (1483% of Medicare)
Ins. Median: $56 (193% 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 |
|---|---|---|
| Aetna | $13 - $306 | 45% |
| Veterans Administration Mill Bill | $20 | 69% |
| Medicare (plans) | $26 - $431 | 89% |
| Humana | $28 - $75 | 96% |
| Devoted Health | $29 | 100% |
| Leon Health Inc | $29 | 100% |
| Tricare | $29 | 100% |
| UnitedHealthcare | $29 - $362 | 100% |
| Bristol Hospice- Miami Dade Llc | $30 | 103% |
| Catholic Hospice | $30 | 103% |
| Compassionate Care Hospice Of Miami Dade And The Fl Keys Inc | $30 | 103% |
| Employer Direct Healthcare | $30 - $37 | 103% |
| Hospice Other | $30 | 103% |
| Ima Evalutations Inc | $30 | 103% |
| Odyssey Healthcare Of Marion County Dba Kindred Hospice | $30 | 103% |
| Opuscare Of South Fl | $30 | 103% |
| Seasons Hospice And Pallative Care Of Southern Florida Inc | $30 | 103% |
| Select Specialty Hospital | $30 | 103% |
| Veterans Administration Vaccn | $30 | 103% |
| Vitas Healthcare Hospice | $30 | 103% |
| Westchester General Hospital | $30 | 103% |
| Cigna | $31 - $215 | 107% |
| Healthsun Health Plans | $31 | 107% |
| Longevity Health Plan | $31 | 107% |
| Dimension Health Wc | $33 | 114% |
| Workers Compensation | $33 | 114% |
| Florida Pace Centers | $35 | 120% |
| Bright Health Management Commercial | $36 | 124% |
| Self Pay/Uninsured | $36 | 124% |
| Naphcare Inc | $41 | 141% |
| Avmed Exchange | $52 | 179% |
| Ambetter / Centene | $55 | 189% |
| Molina Marketplace Program Exchange | $56 | 193% |
| Auto Insurance | $59 | 203% |
| Avmed Select Network | $61 | 210% |
| Amerihealth Caritas Next Exchange | $64 | 220% |
| Bc/Bs Myblue Hmo Hix | $66 | 227% |
| Bc/Bs Of Fl Health Options Hmo | $66 | 227% |
| Bc/Bs Of Fl Network Blue | $66 | 227% |
| Bc/Bs Of Fl Simplyblue | $66 | 227% |
| Bc/Bs Of Fl Blue Select Exchange Non Par | $70 | 241% |
| Bc/Bs Of Fl Ppo | $74 | 255% |
| Bc/Bs Of Fl Miami Dade Blue Select | $87 | 299% |
| Medicaid / KanCare | $108 - $431 | 372% |
| Oscar Health Plan Hix | $114 | 392% |
| Imagine Health | $161 | 554% |
| Avmed Broad Network | $174 | 599% |
| Liga Contra El Cancer | $215 | 740% |
| Bc/Bs Of Fl Phs | $216 | 743% |
| Magellan Behavioral Health | $258 | 888% |
| Dimensions International | $280 | 964% |
| First Health | $288 | 991% |
| Dimension Health Ppo | $323 | 1111% |
| Beacon Health Strategies Commercial | $431 | 1483% |
| Commercial Non-Contracted | $431 | 1483% |
| Self Pay - Mcd Pending 100 Percent | $431 | 1483% |
| Single Case Agreement | $431 | 1483% |
| United Behavioral Health Psych | $431 | 1483% |