CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercyone Dyersville Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $117
Cash Discount Price: $92
vs. Medicare Baseline: 4.03x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercyone Dyersville Medical Center is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $92. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.03x the Medicare baseline. Located in 1111 3Rd Street Sw, Dyersville, IA.

Cash / Self-Pay

$92

Average discount available for prompt cash payment at this facility.

Insurance Median

$117

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: $92 (317%)

Insurance Median: $117 (403%)

Cash: $92 (317% of Medicare)

Ins. Median: $117 (403% 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 403% of the Medicare baseline (a markup of 303%). 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
Health Choices	$54	186%
Blue Cross Blue Shield	$79	272%
Medicare (plans)	$80 - $88	275%
UnitedHealthcare	$84 - $128	289%
The Alliance	$86	296%
Iowa Total Care	$98	337%
Medicaid / KanCare	$100	344%
Amish Hospital Aid	$106	365%
1199 National Benefit Fund	$117	403%
Aetna	$117	403%
Allied Benefit Systems	$117	403%
Asr Health Benefits	$117	403%
Christian Brother Services	$117	403%
Coventry	$117	403%
First Health	$117	403%
Luminare Health	$117	403%
Medical Mutual	$117	403%
Meritain	$117	403%
Trustmark Small Business Benefits	$117	403%
Webtpa	$117	403%
Auxiant	$128	440%
Cigna	$128	440%
Geha	$128	440%
Medica	$128	440%
Midlands	$128	440%
Midlands Choice	$128	440%
Multiplan	$128	440%
Ambetter / Centene	$134	461%
Crime Victim Assistance	$142	489%
Iowa Dept Of Public Health	$142	489%
Claimdoc	$160	551%
Nova	$160	551%

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 $92.
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 Mercyone Dyersville Medical Center 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.