CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercy Hospital Washington

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $77
Cash Discount Price: $71
vs. Medicare Baseline: 2.65x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Hospital Washington is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $71. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.65x the Medicare baseline. Located in 901 East 5Th Street, Washington, MO.

Cash / Self-Pay

$71

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $71 (244%)

Insurance Median: $77 (265%)

Cash: $71 (244% of Medicare)

Ins. Median: $77 (265% 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 265% of the Medicare baseline (a markup of 165%). 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
Medicaid / KanCare	$6 - $145	21%
Aetna	$15 - $184	52%
American Health Advantage Of Mo Mcr [10473]	$26	89%
Blue Cross Blue Shield	$26 - $274	89%
Cherokee Nation Health Serv Contracted [320066]	$26	89%
Cross Timbers Hospice [20098]	$26	89%
Dept Of Veteran Affairs Contracted [320106]	$26	89%
Elara Caring Aspire Hospice Contracted [320433]	$26	89%
Elara Caring Aspire Hospice [20433]	$26	89%
Globalhealth Contracted [320145]	$26	89%
Halo Hcr Inc Hospice Contracted [320432]	$26	89%
Halo Hcr Inc Hospice [20432]	$26	89%
Humana	$26	89%
Kindful Hospice Contracted [320434]	$26	89%
Kindful Hospice [20434]	$26	89%
Medicare (plans)	$26 - $119	89%
Mercy Hospice Okc [20252]	$26	89%
Pace Of The Ozarks Contracted [320518]	$26	89%
Qual Choice Contracted [320325]	$26	89%
Tricare	$26	89%
UnitedHealthcare	$26 - $193	89%
Cigna	$28 - $198	96%
Provider Partners Health Plans Contracted [320450]	$29	100%
Healthscope Contracted [320182]	$33	114%
Centivo Contracted [320505]	$44	151%
Preferred Health Plan Contracted [320522]	$47	162%
Health Choices Contracted [320448]	$60 - $71	206%
Health Choices [20448]	$60 - $71	206%
Medical Associates Health Contracted [320444]	$60 - $71	206%
Hope Trust Contracted [320488]	$63	217%
Federal Medical Center Contracted [320127]	$65 - $77	224%
Insurance System Inc Contracted [320465]	$65 - $77	224%
Point C Contracted [320238]	$65 - $77	224%
Tri State Healthcare Coalition Contracted [320379]	$65 - $77	224%
Healthlink Contracted [320179]	$68 - $225	234%
First Health Contracted [320128]	$70 - $84	241%
Mercy Mgd Behavioral Health Contracted [320259]	$70 - $83	241%
Multiplan Contracted [320270]	$70 - $89	241%
Private Health Care Systems Contracted [320320]	$70 - $83	241%
Workers Comp [20426]	$75 - $95	258%
Medica Contracted [320239]	$137	471%
Ambetter / Centene	$145	499%
Home State Health Plan Contracted [320187]	$145	499%
Novasys Contracted [320285]	$145	499%
Mercy Benefit Admin Contracted [320251]	$170 - $209	585%
Mercy Benefit Admin [20251]	$170 - $209	585%
United Medical Resources Contracted [320454]	$193	664%
Show-Me Health Administrators Contracted [320483]	$203 - $213	699%
Aither Health Contracted [320449]	$209	719%
Aither Health [20449]	$209	719%
Auxiant Contracted [320462]	$209	719%
Ebms Contracted [320493]	$209	719%
Edison Health Solutions Contracted [320502]	$209	719%
Imagine 360 Contracted [320494]	$209	719%
Reflect Health Contracted [320492]	$209	719%
Yuzu Health Contracted [320521]	$209	719%

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 $71.
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 Mercy Hospital Washington 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.