CMS Price Transparency Data
Physical therapy (gait training)
Facility: Mercy Hospital Ada
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $51
- Cash Discount Price: $55
- vs. Medicare Baseline: 1.75x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Hospital Ada is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $55. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.75x the Medicare baseline. Located in 430 North Monte Vista, Ada, OK.
Cash / Self-Pay
$55
Average discount available for prompt cash payment at this facility.
Insurance Median
$51
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: $55 (189%)
Insurance Median: $51 (175%)
Cash: $55 (189% of Medicare)
Ins. Median: $51 (175% 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 - $64 | 89% |
| Humana | $26 - $27 | 89% |
| Medicaid / KanCare | $26 - $37 | 89% |
| Blue Cross Blue Shield | $27 | 93% |
| Cherokee Nation Health Serv Contracted [320066] | $27 | 93% |
| Cross Timbers Hospice [20098] | $27 | 93% |
| Dept Of Veteran Affairs Contracted [320106] | $27 | 93% |
| Elara Caring Aspire Hospice Contracted [320433] | $27 | 93% |
| Elara Caring Aspire Hospice [20433] | $27 | 93% |
| Globalhealth Contracted [320145] | $27 | 93% |
| Halo Hcr Inc Hospice Contracted [320432] | $27 | 93% |
| Halo Hcr Inc Hospice [20432] | $27 | 93% |
| Independent Health [20197] | $27 | 93% |
| Indian Health Service Contracted [320198] | $27 | 93% |
| Kindful Hospice Contracted [320434] | $27 | 93% |
| Kindful Hospice [20434] | $27 | 93% |
| Medical Associates Health [20444] | $27 | 93% |
| Medicare (plans) | $27 - $85 | 93% |
| Mercy Hospice Okc [20252] | $27 | 93% |
| Provider Partners Health Plans Contracted [320450] | $27 | 93% |
| Qual Choice Contracted [320325] | $27 | 93% |
| Tricare | $27 | 93% |
| UnitedHealthcare | $27 - $60 | 93% |
| Cigna | $28 | 96% |
| Healthcare Highways Plus Contracted [320175] | $33 - $64 | 114% |
| Webtpa Contracted [320417] | $36 | 124% |
| Ambetter / Centene | $37 | 127% |
| Home State Health Plan Contracted [320187] | $37 | 127% |
| Novasys Contracted [320285] | $37 | 127% |
| Workers Comp [20426] | $37 | 127% |
| Osma Health Contracted [320292] | $38 | 131% |
| Benefit Management Contracted [320052] | $42 - $55 | 145% |
| Health Choice Contracted [320166] | $45 | 155% |
| Aither Health Contracted [320449] | $51 | 175% |
| Auxiant Contracted [320462] | $51 | 175% |
| Ebms Contracted [320493] | $51 | 175% |
| Federal Medical Center Contracted [320127] | $51 | 175% |
| Healthlink Contracted [320179] | $51 | 175% |
| Healthscope Contracted [320182] | $51 | 175% |
| Imagine 360 Contracted [320494] | $51 | 175% |
| Mercy Benefit Admin Contracted [320251] | $51 - $55 | 175% |
| Point C Contracted [320238] | $51 | 175% |
| Preferred Health Plan Contracted [320522] | $51 | 175% |
| Quik Trip Contracted [320447] | $51 | 175% |
| Reflect Health Contracted [320492] | $51 | 175% |
| Show-Me Health Administrators Contracted [320483] | $51 | 175% |
| United Medical Resources Contracted [320454] | $51 - $60 | 175% |
| Yuzu Health Contracted [320521] | $51 | 175% |
| Globalhealth Contracted [320144] | $54 | 186% |
| Healthsmart Preferred Care Contracted [320184] | $60 | 206% |
| Kempton Contracted [320214] | $60 | 206% |
| First Health Contracted [320128] | $71 | 244% |
| Multiplan Contracted [320270] | $72 | 248% |
| Private Health Care Systems Contracted [320320] | $72 | 248% |
| Medica Contracted [320239] | $85 - $95 | 292% |