CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercy Hospital Stoddard

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $38
Cash Discount Price: $67
vs. Medicare Baseline: 1.31x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Hospital Stoddard is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $67. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.31x the Medicare baseline. Located in 1200 N One Mile Rd, Dexter, MO.

Cash / Self-Pay

$67

Average discount available for prompt cash payment at this facility.

Insurance Median

$38

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: $67 (231%)

Insurance Median: $38 (131%)

Cash: $67 (231% of Medicare)

Ins. Median: $38 (131% 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.

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	$15 - $103	52%
Acentra Health Contracted [320527]	$26	89%
Aetna	$26 - $77	89%
Blue Cross Blue Shield	$26 - $93	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%
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 - $28	89%
Mercy Hospice Okc [20252]	$26	89%
Pace Of The Ozarks Contracted [320518]	$26	89%
Tricare	$26	89%
UnitedHealthcare	$26 - $39	89%
Ambetter / Centene	$27	93%
American Health Advantage Of Mo Mcr Hmo Contracted [320264]	$27	93%
Home State Health Plan Contracted [320187]	$27	93%
Hope Trust Contracted [320488]	$27	93%
Provider Partners Health Plans Contracted [320450]	$30	103%
United Medical Resources Contracted [320454]	$30	103%
Consociate Consolidated Health Contracted [320490]	$37 - $59	127%
Auxiant Contracted [320462]	$44 - $54	151%
Ebms Contracted [320493]	$44	151%
Healthlink Contracted [320179]	$44 - $82	151%
Imagine 360 Contracted [320494]	$44	151%
Mercy Benefit Admin Contracted [320251]	$44 - $70	151%
Preferred Health Plan Contracted [320522]	$47	162%
Reflect Health Contracted [320492]	$48	165%
Health Alliance Contracted [320164]	$67	231%
Aither Health Contracted [320449]	$70	241%
Edison Health Solutions Contracted [320502]	$70	241%
Mercy Benefit Admin [20251]	$70	241%
Yuzu Health Contracted [320521]	$70	241%
First Health Contracted [320128]	$77	265%
Workers Comp [20426]	$77 - $82	265%
Multiplan Contracted [320270]	$82	282%
Private Health Care Systems Contracted [320320]	$82	282%
Cigna	$257	884%

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 $67.
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 Stoddard 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.