CMS Price Transparency Data
Physical therapy (gait training)
Facility: Melrosewakefield Healthcare
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $101
- Cash Discount Price: $133
- vs. Medicare Baseline: 3.48x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Melrosewakefield Healthcare is $101. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.48x the Medicare baseline. Located in 585 Lebanon Street, Melrose, MA.
Cash / Self-Pay
$133
Average discount available for prompt cash payment at this facility.
Insurance Median
$101
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: $133 (458%)
Insurance Median: $101 (348%)
Cash: $133 (458% of Medicare)
Ins. Median: $101 (348% 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 348% of the Medicare baseline (a markup of 248%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Allied Benefit Systems [100015] | $64 - $70 | 220% |
| Allied National Global Care [100107] | $64 - $70 | 220% |
| American Postal Workers [100089] | $64 - $70 | 220% |
| Amerihealth Caritas Nh [350007] | $64 - $70 | 220% |
| Assurant [100020] | $64 - $70 | 220% |
| Avmed Health Plan [100247] | $64 - $70 | 220% |
| Benemax [100276] | $64 - $70 | 220% |
| Care One [950007] | $64 - $70 | 220% |
| Carecentrix Alternate [100257] | $64 - $70 | 220% |
| Cigna | $64 - $449 | 220% |
| Compsych [100027] | $64 - $70 | 220% |
| Coresource [100285] | $64 - $70 | 220% |
| Coventry [100010] | $64 - $70 | 220% |
| Coverage Discovery [100306] | $64 - $70 | 220% |
| D'Youville Senior Care [950003] | $64 - $70 | 220% |
| Employee Benefit Management [100033] | $64 - $70 | 220% |
| Eyemed [100290] | $64 - $70 | 220% |
| First Health [100278] | $64 - $70 | 220% |
| Geha [100039] | $64 - $70 | 220% |
| Generic Commercial [109999] | $64 - $70 | 220% |
| Group And Pension Administrators [100043] | $64 - $70 | 220% |
| Ibew Local 103 [100272] | $64 - $70 | 220% |
| Lowell Comm Health Center [950009] | $64 - $70 | 220% |
| Medicaid / KanCare | $64 - $199 | 220% |
| Medicare (plans) | $64 - $70 | 220% |
| Mutual Of Omaha [100074] | $64 - $70 | 220% |
| National Association Of Letter Carriers [100067] | $64 - $70 | 220% |
| National Elevator Ind Hlth Benefits [100273] | $64 - $70 | 220% |
| Norfolk County [500013] | $64 - $70 | 220% |
| Northwood Rehabilitation & Health [950004] | $64 - $70 | 220% |
| Nova Healthcare Administrators [100270] | $64 - $70 | 220% |
| Palm Manor [950005] | $64 - $70 | 220% |
| Plymouth County [500019] | $64 - $70 | 220% |
| Spectera [100291] | $64 - $70 | 220% |
| Tall Tree Administrators [100271] | $64 - $70 | 220% |
| Ultra Benefits [100280] | $64 - $70 | 220% |
| Umass Disability [500017] | $64 - $70 | 220% |
| Tufts Health Public Plan Connectorcare [100264] | $68 - $105 | 234% |
| Blue Cross Blue Shield | $69 - $183 | 237% |
| Wellpoint [100139] | $73 | 251% |
| Blue Benefits Administrators [100267] | $78 - $183 | 268% |
| Tufts Health Plan [100263] | $84 - $94 | 289% |
| Wc Acadia Insurance Company [700108] | $101 - $111 | 348% |
| Wc Aig [700029] | $101 - $111 | 348% |
| Wc Aim Mutual Insurance [700054] | $101 - $111 | 348% |
| Wc Alternative Service Concept [700065] | $101 - $111 | 348% |
| Wc Ameritrust [700066] | $101 - $111 | 348% |
| Wc Arrow Mutual Liability [700063] | $101 - $111 | 348% |
| Wc Atlantic Charter [700064] | $101 - $111 | 348% |
| Wc Berkshire Hathaway [700046] | $101 - $111 | 348% |
| Wc Boston Police And Firefighter [700061] | $101 - $111 | 348% |
| Wc Broadspire [700043] | $101 - $111 | 348% |
| Wc Careworks [700109] | $101 - $111 | 348% |
| Wc Cbcs [700110] | $101 - $111 | 348% |
| Wc Ccmsi [700055] | $101 - $111 | 348% |
| Wc Chubb Group [700067] | $101 - $111 | 348% |
| Wc Cic/Mcmc [700068] | $101 - $111 | 348% |
| Wc City Of Boston [700111] | $101 - $111 | 348% |
| Wc City Of Cambridge [700069] | $101 - $111 | 348% |
| Wc City Of Chelsea [700070] | $101 - $111 | 348% |
| Wc City Of Everett [700071] | $101 - $111 | 348% |
| Wc City Of Lowell [700062] | $101 - $111 | 348% |
| Wc City Of Lynn [700072] | $101 - $111 | 348% |
| Wc City Of Medford [700073] | $101 - $111 | 348% |
| Wc City Of Melrose Police [700112] | $101 - $111 | 348% |
| Wc City Of Melrose [700113] | $101 - $111 | 348% |
| Wc City Of Newton [700074] | $101 - $111 | 348% |
| Wc City Of Peabody [700075] | $101 - $111 | 348% |
| Wc City Of Revere [700076] | $101 - $111 | 348% |
| Wc City Of Somerville [700077] | $101 - $111 | 348% |
| Wc Cna [700048] | $101 - $111 | 348% |
| Wc Commonwealth Of Mass [700056] | $101 - $111 | 348% |
| Wc Consigly Construction [700079] | $101 - $111 | 348% |
| Wc Constitution State Services [700114] | $101 - $111 | 348% |
| Wc Continental Indemnity Co [700078] | $101 - $111 | 348% |
| Wc Corvel [700115] | $101 - $111 | 348% |
| Wc Cove Risk Services [700080] | $101 - $111 | 348% |
| Wc Creative Risk Solutions [700081] | $101 - $111 | 348% |
| Wc Crum & Forster [700082] | $101 - $111 | 348% |
| Wc Demoulas Supermarket [700083] | $101 - $111 | 348% |
| Wc Emc Insurance Company [700084] | $101 - $111 | 348% |
| Wc Energy Of Environmental Affairs [700085] | $101 - $111 | 348% |
| Wc Esis [700010] | $101 - $111 | 348% |
| Wc Federated Work Comp [700012] | $101 - $111 | 348% |
| Wc Future Comp [700116] | $101 - $111 | 348% |
| Wc Gallagher Bassett Work Comp [700013] | $101 - $111 | 348% |
| Wc Geico [700057] | $101 - $111 | 348% |
| Wc Generic Workers' Comp [709999] | $101 - $111 | 348% |
| Wc Gowry Group [700086] | $101 - $111 | 348% |
| Wc Hartford Insurance [700058] | $101 - $111 | 348% |
| Wc Hrd/Workers Compensation Unit [700087] | $101 - $111 | 348% |
| Wc Liberty Mutual Work Comp [700016] | $101 - $111 | 348% |
| Wc Mapfre Insurance [700089] | $101 - $111 | 348% |
| Wc Mass Nahro Insurance Group Trust [700090] | $101 - $111 | 348% |
| Wc Mass State Police [700091] | $101 - $111 | 348% |
| Wc Mbta [700092] | $101 - $111 | 348% |
| Wc Meditrol [700093] | $101 - $111 | 348% |
| Wc Memic [700117] | $101 - $111 | 348% |
| Wc Metlife [700094] | $101 - $111 | 348% |
| Wc Miia [700095] | $101 - $111 | 348% |
| Wc Ml Healthcare Services Llc [700119] | $101 - $111 | 348% |
| Wc Norfolk & Dedham Group [700096] | $101 - $111 | 348% |
| Wc Norguard Ins Co [700097] | $101 - $111 | 348% |
| Wc One Call Medical [700060] | $101 - $111 | 348% |
| Wc Plumbers Union Local No 12 [700098] | $101 - $111 | 348% |
| Wc Plymouth Rock [700099] | $101 - $111 | 348% |
| Wc Pma Work Comp [700031] | $101 - $111 | 348% |
| Wc Progressive Direct Insurance Co [700106] | $101 - $111 | 348% |
| Wc Retail Business Services Llc [700100] | $101 - $111 | 348% |
| Wc Rising Medical Solution [700101] | $101 - $111 | 348% |
| Wc Sedgwick [700027] | $101 - $111 | 348% |
| Wc Selective Insurance Co [700118] | $101 - $111 | 348% |
| Wc Sentry [700036] | $101 - $111 | 348% |
| Wc Sutter House [700102] | $101 - $111 | 348% |
| Wc Town Of Andover Fire Dept [700103] | $101 - $111 | 348% |
| Wc Town Of Arlington [700104] | $101 - $111 | 348% |
| Wc Travelers Insurance [700059] | $101 - $111 | 348% |
| Wc Us Department Of Labor [700023] | $101 - $111 | 348% |
| Wc Vermont Mutual Insurance Group [700105] | $101 - $111 | 348% |
| Wc York Risk Services [700049] | $101 - $111 | 348% |
| Wc Zurich [700034] | $101 - $111 | 348% |
| Allaracare [100163] | $105 - $115 | 361% |
| Harvard Pilgrim Healthcare [100241] | $116 - $298 | 399% |
| Health Plans Inc [100262] | $116 - $298 | 399% |
| UnitedHealthcare | $116 - $298 | 399% |
| Claritev/Multiplan [100275] | $160 - $175 | 551% |
| Cypress Benefit Administrators [100122] | $160 - $175 | 551% |
| Health New England [100268] | $160 - $175 | 551% |
| Patient Advocates [100307] | $160 - $175 | 551% |
| Meritain [100063] | $197 - $215 | 678% |
| Health Safety Net [500011] | $531 | 1827% |