CMS Price Transparency Data
Physical therapy (gait training)
Facility: Mercy Health Lakeshore Campus
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $106
- Cash Discount Price: $80
- vs. Medicare Baseline: 3.65x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Health Lakeshore Campus is $106. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.65x the Medicare baseline. Located in 72 South State Street, Shelby, MI.
Cash / Self-Pay
$80
Average discount available for prompt cash payment at this facility.
Insurance Median
$106
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: $80 (275%)
Insurance Median: $106 (365%)
Cash: $80 (275% of Medicare)
Ins. Median: $106 (365% 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 365% of the Medicare baseline (a markup of 265%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $21 - $105 | 72% |
| Medicaid / KanCare | $21 | 72% |
| Access Health | $22 | 76% |
| Blue Care Network Advantage | $30 | 103% |
| Medicare (plans) | $30 | 103% |
| Aetna | $31 - $98 | 107% |
| Align Senior Care | $31 | 107% |
| Correctional Recovery | $31 | 107% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $35 | 120% |
| Oscar | $38 | 131% |
| Vitalcore | $41 | 141% |
| UnitedHealthcare | $43 - $111 | 148% |
| Wellpath | $43 | 148% |
| U Of M Health Plan | $44 - $110 | 151% |
| Molina Marketplace | $51 | 175% |
| Hospice Of Michigan | $68 | 234% |
| Nomi Health | $69 | 237% |
| Hap | $92 - $113 | 317% |
| Wc Accident Fund | $97 | 334% |
| Wc Advantage | $97 | 334% |
| Wc Aig | $97 | 334% |
| Wc Allied | $97 | 334% |
| Wc Amerisure | $97 | 334% |
| Wc Amtrust | $97 | 334% |
| Wc Asu Risk Mgt | $97 | 334% |
| Wc Berkley Admin | $97 | 334% |
| Wc Broadspire | $97 | 334% |
| Wc Bunch & Associates | $97 | 334% |
| Wc Ccmsi | $97 | 334% |
| Wc Emc Insurance Company | $97 | 334% |
| Wc Esis | $97 | 334% |
| Wc Fcci | $97 | 334% |
| Wc Federated | $97 | 334% |
| Wc Gallagher Bassett | $97 | 334% |
| Wc Genex Care For Ohio | $97 | 334% |
| Wc Guard Insurance Company | $97 | 334% |
| Wc Hartford | $97 | 334% |
| Wc Liberty Mutual | $97 | 334% |
| Wc Meijers | $97 | 334% |
| Wc Michigan | $97 | 334% |
| Wc Mitchell Frankenmuth | $97 | 334% |
| Wc Pma | $97 | 334% |
| Wc Sedgwick | $97 | 334% |
| Wc Sentry | $97 | 334% |
| Wc Travelers | $97 | 334% |
| Wc Tristar | $97 | 334% |
| Wc Walmart | $97 | 334% |
| Wc Zurich | $97 | 334% |
| Geha | $98 - $111 | 337% |
| Meritain | $98 | 337% |
| Asr Health Benefits | $102 | 351% |
| Bcn Domestic | $105 | 361% |
| Blue Benefit Administrators Of Massachusetts | $105 | 361% |
| Blue Care Network | $105 | 361% |
| Blue Distinction Transplant | $105 | 361% |
| Blue Shield - Ca | $105 | 361% |
| Blue Shield - Id (Regence) | $105 | 361% |
| Blue Shield - Ny Highmark Northeastern | $105 | 361% |
| Blue Shield - Ny Highmark Western | $105 | 361% |
| Blue Shield - Pa (Highmark) | $105 | 361% |
| Blue Shield - Wa (Regence) | $105 | 361% |
| Health Choices | $105 - $110 | 361% |
| Kaiser Domestic | $105 | 361% |
| 1199 National Benefit Fund | $106 | 365% |
| Allied National Global Care | $106 | 365% |
| Asrm - Reliance Standard Life Insurance | $106 | 365% |
| Christian Care Ministry | $106 | 365% |
| Dean Health | $106 | 365% |
| Fallon Health | $106 | 365% |
| Family Life Insurance Company | $106 | 365% |
| Ghc Scw | $106 | 365% |
| Group Pension Administrators | $106 | 365% |
| International Benefit Administrators | $106 | 365% |
| Lifetime Benefit Solutions | $106 | 365% |
| Manhattan Life | $106 | 365% |
| Medi Share | $106 | 365% |
| Multiplan | $106 | 365% |
| Mvp | $106 | 365% |
| Pai | $106 | 365% |
| Pan-American Life | $106 | 365% |
| Paramount Hmo | $106 | 365% |
| Phcs | $106 | 365% |
| Trinity Health Share | $106 | 365% |
| Cigna | $107 | 368% |
| Acclaim | $110 | 379% |
| Administrative Concepts | $110 | 379% |
| Allegeant | $110 | 379% |
| Allied Benefit Systems | $110 | 379% |
| Ameriben | $110 | 379% |
| American Family | $110 | 379% |
| American Healthcare Alliance | $110 | 379% |
| American Republic | $110 | 379% |
| Amerihealth | $110 | 379% |
| Aultcare | $110 | 379% |
| Automated Benefit Services | $110 | 379% |
| Auxiant | $110 | 379% |
| Benefit Administrative Systems,Llc | $110 | 379% |
| Boon Chapman | $110 | 379% |
| Cam Administrative Services | $110 | 379% |
| Caresource | $110 | 379% |
| Christian Brother Services | $110 | 379% |
| Christian Brothers Holy Cross | $110 | 379% |
| Claimchoice Adminstrators | $110 | 379% |
| Comprehensive Benefits | $110 | 379% |
| Consociate | $110 | 379% |
| Continental Life Insurance | $110 | 379% |
| Custom Benefit Administrators | $110 | 379% |
| Cypress Benefit Administrators | $110 | 379% |
| Employee Benefit Concepts | $110 | 379% |
| Employee Benefit Management | $110 | 379% |
| Enterprise Group Planning | $110 | 379% |
| Forest County Potawatomi | $110 | 379% |
| Freedom Life Insurance Company | $110 | 379% |
| Group Administrators | $110 | 379% |
| Group Marketing Services | $110 | 379% |
| Guardian | $110 | 379% |
| Health America | $110 | 379% |
| Health Smart | $110 | 379% |
| Healthez | $110 | 379% |
| Healthgram | $110 | 379% |
| Healthscope | $110 | 379% |
| Humana | $110 | 379% |
| Insight | $110 | 379% |
| Intercare | $110 | 379% |
| Jfp Benefit Management | $110 | 379% |
| Jp Farley Corporation | $110 | 379% |
| Key Benefit Administrator | $110 | 379% |
| Liberty Union Life Assurance Co | $110 | 379% |
| Lucent Health | $110 | 379% |
| Luminare Health | $110 | 379% |
| Luminare Health (Detroit) | $110 | 379% |
| Medben | $110 | 379% |
| Medcost | $110 | 379% |
| Medical Mutual | $110 | 379% |
| Mutual Health Services | $110 | 379% |
| Mutual Of Omaha | $110 | 379% |
| Ncas | $110 | 379% |
| Nippon Life Ins | $110 | 379% |
| Nova | $110 | 379% |
| Painters Union Insurance Fund | $110 | 379% |
| Physicians Mutual | $110 | 379% |
| Plumbers Local 98 Insurance Fund | $110 | 379% |
| Prairie States | $110 | 379% |
| Primary Physician Care | $110 | 379% |
| Professional Benefit Administrators | $110 | 379% |
| Secureone Preferred United Plans | $110 | 379% |
| The Loomis Company | $110 | 379% |
| Trustmark Small Business Benefits | $110 | 379% |
| Unicare | $110 | 379% |
| Unified Group Services | $110 | 379% |
| Us Health And Life | $110 | 379% |
| Valenz | $110 | 379% |
| Varipro | $110 - $113 | 379% |
| Western & Southern Financial Group | $110 | 379% |
| Wps | $110 | 379% |
| First Health | $111 | 382% |
| Priority Health | $111 | 382% |