CMS Price Transparency Data
Physical therapy (gait training)
Facility: Mercy Hospital Springfield
Billing Code: 97116 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97116
- Insurance Median: $95
- Cash Discount Price: $109
- vs. Medicare Baseline: 3.27x Medicare
The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Hospital Springfield is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $109. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.27x the Medicare baseline. Located in 2115 S. Fremont Ave, Springfield, MO.
Cash / Self-Pay
$109
Average discount available for prompt cash payment at this facility.
Insurance Median
$95
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: $109 (375%)
Insurance Median: $95 (327%)
Cash: $109 (375% of Medicare)
Ins. Median: $95 (327% 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 327% of the Medicare baseline (a markup of 227%). 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.
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 |
|---|---|---|
| Blue Cross Blue Shield | $24 - $236 | 83% |
| Medicaid / KanCare | $24 - $68 | 83% |
| Aetna | $26 - $56 | 89% |
| Centivo Contracted [320505] | $26 | 89% |
| Centurion Of Missouri [20459] | $26 | 89% |
| Champva [20065] | $26 | 89% |
| Cherokee Nation Health Serv Contracted [320066] | $26 | 89% |
| Cigna | $26 - $129 | 89% |
| Cross Timbers Hospice [20098] | $26 | 89% |
| Dept Of Veteran Affairs Contracted [320106] | $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 - $114 | 89% |
| Indian Health Service Contracted [320198] | $26 | 89% |
| Indian Health Service [20198] | $26 | 89% |
| Kindful Hospice Contracted [320434] | $26 | 89% |
| Kindful Hospice [20434] | $26 | 89% |
| Medicare (plans) | $26 - $28 | 89% |
| Mercy Hospice Okc [20252] | $26 | 89% |
| Mercy Mgd Behavioral Health Contracted [320259] | $26 | 89% |
| Mercy Rehab Hospital Contracted [320260] | $26 | 89% |
| Pace Of The Ozarks Contracted [320518] | $26 | 89% |
| Qual Choice Contracted [320325] | $26 | 89% |
| Tricare | $26 | 89% |
| UnitedHealthcare | $26 - $487 | 89% |
| Provider Partners Health Plans Contracted [320450] | $29 | 100% |
| Healthscope Contracted [320182] | $33 | 114% |
| Providrs Care Network Contracted [320484] | $52 | 179% |
| Medica Contracted [320239] | $66 | 227% |
| Medica [20239] | $66 | 227% |
| Benefit Management Contracted [320052] | $67 | 231% |
| Health Systems Inc Contracted [320174] | $67 | 231% |
| Insurance System Inc Contracted [320465] | $67 | 231% |
| Ambetter / Centene | $68 | 234% |
| Home State Health Plan Contracted [320187] | $68 | 234% |
| Novasys Contracted [320285] | $68 | 234% |
| Administrative Payor Contracted [320005] | $75 - $84 | 258% |
| Evolutions Health Care Contracted [320124] | $75 | 258% |
| Point C Contracted [320238] | $75 - $125 | 258% |
| Point C [20238] | $75 | 258% |
| Medical Destinations Contracted [320242] | $84 | 289% |
| Mercy Benefit Admin Contracted [320251] | $84 - $195 | 289% |
| Workers Comp [20426] | $84 - $142 | 289% |
| United Medical Resources Contracted [320454] | $87 - $315 | 299% |
| First Health Contracted [320128] | $94 | 323% |
| Aither Health Contracted [320449] | $95 | 327% |
| Auxiant Contracted [320462] | $95 - $109 | 327% |
| Ebms Contracted [320493] | $95 | 327% |
| Edison Health Solutions Contracted [320502] | $95 | 327% |
| Healthlink Contracted [320179] | $95 - $134 | 327% |
| Imagine 360 Contracted [320494] | $95 | 327% |
| Reflect Health Contracted [320492] | $95 | 327% |
| Yuzu Health Contracted [320521] | $95 | 327% |
| 90 Degree Benefits Contracted [320436] | $100 - $195 | 344% |
| Federal Medical Center Contracted [320127] | $100 | 344% |
| Show-Me Health Administrators Contracted [320483] | $100 - $195 | 344% |
| Multiplan Contracted [320270] | $129 | 444% |
| Private Health Care Systems Contracted [320320] | $129 | 444% |
| Compcare Of The Ozarks Contracted [320437] | $132 | 454% |
| American Healthcare Alliance Contracted [320020] | $134 | 461% |
| Qual Choice Contracted [320324] | $134 | 461% |
| Municipal Health Plan Contracted [320271] | $135 | 465% |
| Usa Managed Care Org Contracted [320429] | $147 | 506% |
| Ppo Plus Contracted [320310] | $150 | 516% |