CMS Price Transparency Data

Physical therapy (gait training)

Facility: Nemours Childrens Hospital, Florida

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $278
Cash Discount Price: $844
vs. Medicare Baseline: 9.57x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Nemours Childrens Hospital, Florida is $278. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $844. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 9.57x the Medicare baseline. Located in 6535 Nemours Pkwy, Orlando, FL.

Cash / Self-Pay

$844

Average discount available for prompt cash payment at this facility.

Insurance Median

$278

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: $844 (2904%)

Insurance Median: $278 (957%)

Cash: $844 (2904% of Medicare)

Ins. Median: $278 (957% 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 957% of the Medicare baseline (a markup of 857%). 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
Tricare	$28	96%
Avmed	$108 - $415	372%
Employers Health Network Fl	$140 - $535	482%
Florida Blue	$140 - $816	482%
Truli	$140 - $535	482%
Aetna	$154 - $589	530%
Evolutions Healthcare	$158 - $602	544%
Integra Administrative Group	$210 - $803	723%
Global Medical Management	$228 - $870	785%
Prime Health Services	$228 - $870	785%
Star Healthcare Network	$228 - $870	785%
UnitedHealthcare	$246	847%
Cigna	$248	853%
Velocity	$262 - $1,004	902%
First Health Network	$273 - $1,044	939%
Pnoa	$280 - $1,070	964%
Seminole Tribe Of Fl	$280 - $1,070	964%
Private Healthcare Systems	$322 - $1,231	1108%

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 $844.
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 Nemours Childrens Hospital, Florida 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.