CMS Price Transparency Data

Physical therapy (gait training)

Facility: St Catherine's Rehabilitation Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97116
  • Insurance Median: $27
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 0.93x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at St Catherine's Rehabilitation Hospital is $27. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 0.93x the Medicare baseline. Located in 1050 N E 125Th Street, North Miami, FL.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$27

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%)
Insurance Median: $27 (93%)
Ins. Median: $27 (93% 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
Blue Cross Blue Shield $18 62%
Careplus $18 62%
Metra Comp $21 72%
Medica $22 76%
Integrated Health $24 83%
Medin-Crease Health Plan $24 - $27 83%
Coventry $25 86%
Humana $25 86%
Positive $25 86%
Rockport $25 - $29 86%
Concordia $32 110%
Dimension Health $32 110%
Preferred Care Partners $32 110%
Prime Health Care Partners $32 110%
UnitedHealthcare $32 110%
Wellcare $32 110%
Molina Hc $55 189%
Avmed $60 206%
Cigna $65 224%
Simply $75 258%
Doctors $80 275%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1050 N E 125Th Street, North Miami, FL 33161
  • CMS Rating: No CMS Rating
  • Ownership Type: N/A
  • Hospital Type: PART A PROVIDER - HOSPITAL