CMS Price Transparency Data
Physical therapy (gait training)
Facility: Mercy Hospital Waldron
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $42
- Cash Discount Price: $66
- vs. Medicare Baseline: 1.45x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Hospital Waldron is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $66. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.45x the Medicare baseline. Located in 1341 West Sixth Street, Waldron, AR.
Cash / Self-Pay
$66
Average discount available for prompt cash payment at this facility.
Insurance Median
$42
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: $66 (227%)
Insurance Median: $42 (145%)
Cash: $66 (227% of Medicare)
Ins. Median: $42 (145% 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 | $26 - $66 | 89% |
| Humana | $26 - $86 | 89% |
| Medicaid / KanCare | $26 - $39 | 89% |
| Tricare | $27 | 93% |
| American Health Advantage Of Mo Mcr [20264] | $28 | 96% |
| Blue Cross Blue Shield | $28 - $42 | 96% |
| Cherokee Nation Health Serv Contracted [320066] | $28 | 96% |
| Cross Timbers Hospice [20098] | $28 | 96% |
| Dept Of Veteran Affairs Contracted [320106] | $28 | 96% |
| Elara Caring Aspire Hospice Contracted [320433] | $28 | 96% |
| Elara Caring Aspire Hospice [20433] | $28 | 96% |
| Globalhealth Contracted [320145] | $28 | 96% |
| Halo Hcr Inc Hospice Contracted [320432] | $28 | 96% |
| Halo Hcr Inc Hospice [20432] | $28 | 96% |
| Independent Health [20197] | $28 | 96% |
| Indian Health Service Contracted [320198] | $28 | 96% |
| Indian Health Service [20198] | $28 | 96% |
| Jordan Valley Senior Care Pace [20515] | $28 | 96% |
| Kindful Hospice Contracted [320434] | $28 | 96% |
| Kindful Hospice [20434] | $28 | 96% |
| Medical Associates Health [20444] | $28 | 96% |
| Medicare (plans) | $28 - $29 | 96% |
| Mercy Hospice Okc [20252] | $28 | 96% |
| Pace Of The Ozarks [20518] | $28 | 96% |
| Provider Partners Health Plans Contracted [320450] | $28 | 96% |
| Qual Choice Contracted [320325] | $28 | 96% |
| Spina Bifida Hlthcare Benefit [20506] | $28 | 96% |
| UnitedHealthcare | $28 - $186 | 96% |
| Valir Pace [20503] | $28 | 96% |
| Cigna | $29 - $86 | 100% |
| Ambetter / Centene | $39 | 134% |
| Home State Health Plan Contracted [320187] | $39 | 134% |
| Novasys Contracted [320285] | $39 - $71 | 134% |
| Usable Contracted [320409] | $42 | 145% |
| Mercy Interfacility [20513] | $45 | 155% |
| Auxiant Contracted [320462] | $61 - $91 | 210% |
| Mercy Benefit Admin Contracted [320251] | $61 - $91 | 210% |
| Workers Comp [20426] | $66 | 227% |
| 90 Degree Benefits Contracted [320436] | $86 | 296% |
| Aither Health Contracted [320449] | $86 | 296% |
| Ebms Contracted [320493] | $86 | 296% |
| Edison Health Solutions Contracted [320502] | $86 | 296% |
| Healthlink Contracted [320179] | $86 - $91 | 296% |
| Imagine 360 Contracted [320494] | $86 | 296% |
| Multiplan Contracted [320270] | $86 | 296% |
| Multiplan [20270] | $86 | 296% |
| Municipal Health Plan Contracted [320271] | $86 | 296% |
| Qual Choice Contracted [320324] | $86 | 296% |
| Reflect Health Contracted [320492] | $86 | 296% |
| Show-Me Health Administrators Contracted [320483] | $86 | 296% |
| Federal Medical Center Contracted [320127] | $91 | 313% |
| Healthscope Contracted [320182] | $91 | 313% |
| Insurance System Inc Contracted [320465] | $91 | 313% |
| Personify Health Contracted [320051] | $91 | 313% |
| Point C Contracted [320238] | $91 | 313% |
| Preferred Health Plan Contracted [320522] | $91 | 313% |
| Tri State Healthcare Coalition Contracted [320379] | $91 | 313% |
| United Medical Resources Contracted [320454] | $186 | 640% |