CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercy Health Lakeshore Campus

Billing Code: 97116 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$37

about 1.3× the $29 Medicare rate · typically $26–$59

modeled estimate · not a bill or quote

What this hospital charges insurers

$43

Above the fair price

about $6 over the fair price · 1.5× Medicare

Medicare pays $29 Fair price $37 This hospital $43 Cash price $80 Hospital's list price $123

How we calculate the fair BaseRate →

How this hospital compares to other MI hospitals

Highest price of the 9 MI hospitals we have prices for — worth calling around.

Cheapest $14 Priciest $43

Black dot = this hospital, among the 9 MI hospitals with a price for this procedure. Full list below.

A fair price for a Physical therapy (gait training) is about $37 (about 1.3× the $29 Medicare rate). Mercy Health Lakeshore Campus charges insurers about $43, or about $80 in cash — above the fair price. Located in Shelby, MI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $37. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$43 - $111	148%
Blue Cross Blue Shieldmajor	$21 - $105	72%
Aetnamajor	$31 - $98	107%
Cignamajor	$107	368%
Humanamajor	$110	379%
Kaiser Permanentemajor	$105	361%
AmeriHealth	$110	379%
CareSource	$110	379%
Dean Health Plan	$106	365%
GEHA	$98 - $111	337%
Medical Mutual	$110	379%
Molina	$51	175%
MVP Health Care	$106	365%
Oscar Health	$38	131%
Paramount	$106	365%
Priority Health	$111	382%
UniCare	$110	379%
+ 119 smaller / regional plans	$22 - $113

Government programs also on file: Medicare, Medicaid.

Excludes 8 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 80), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97116.

Insurance Before you use insurance

Call your insurance company to confirm Mercy Health Lakeshore Campus is in-network.
Ask your insurer whether prior approval is required for CPT code 97116.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mercy Health Lakeshore Campus

Compare: Physical therapy (gait training) at other MI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.