CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercy Hospital Lincoln

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $96
Cash Discount Price: $83
vs. Medicare Baseline: 3.30x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Hospital Lincoln is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.30x the Medicare baseline. Located in 1000 East Cherry Street, Troy, MO.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $83 (286%)

Insurance Median: $96 (330%)

Cash: $83 (286% of Medicare)

Ins. Median: $96 (330% 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 330% of the Medicare baseline (a markup of 230%). 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	$8 - $59	28%
Aetna	$19 - $84	65%
Tricare	$27	93%
Medicare (plans)	$28 - $128	96%
UnitedHealthcare	$28 - $84	96%
American Health Advantage Of Mo Mcr [10473]	$30	103%
Blue Cross Blue Shield	$30 - $202	103%
Cherokee Nation Health Serv Contracted [320066]	$30	103%
Cross Timbers Hospice [20098]	$30	103%
Dept Of Veteran Affairs Contracted [320106]	$30	103%
Elara Caring Aspire Hospice Contracted [320433]	$30	103%
Elara Caring Aspire Hospice [20433]	$30	103%
Globalhealth Contracted [320145]	$30	103%
Halo Hcr Inc Hospice Contracted [320432]	$30	103%
Halo Hcr Inc Hospice [20432]	$30	103%
Humana	$30 - $115	103%
Indian Health Service Contracted [320198]	$30	103%
Kindful Hospice Contracted [320434]	$30	103%
Kindful Hospice [20434]	$30	103%
Mercy Hospice Okc [20252]	$30	103%
Pace Of The Ozarks Contracted [320518]	$30	103%
Provider Partners Health Plans Contracted [320450]	$30	103%
Qual Choice Contracted [320325]	$30	103%
Cigna	$32 - $106	110%
Centivo Contracted [320505]	$46	158%
Medica Contracted [320239]	$54	186%
Ambetter / Centene	$59	203%
Home State Health Plan Contracted [320187]	$59	203%
Novasys Contracted [320285]	$59	203%
Hope Trust Contracted [320488]	$63	217%
Health Choices Contracted [320448]	$77	265%
Health Choices [20448]	$77	265%
Medical Associates Health Contracted [320444]	$77	265%
First Health Contracted [320128]	$84 - $96	289%
United Medical Resources Contracted [320454]	$84	289%
Mercy Mgd Behavioral Health Contracted [320259]	$96	330%
Multiplan Contracted [320270]	$96	330%
Private Health Care Systems Contracted [320320]	$96	330%
Workers Comp [20426]	$96 - $102	330%
Healthlink Contracted [320179]	$104 - $114	358%
Aither Health Contracted [320449]	$109	375%
Aither Health [20449]	$109	375%
Auxiant Contracted [320462]	$109	375%
Ebms Contracted [320493]	$109	375%
Edison Health Solutions Contracted [320502]	$109	375%
Federal Medical Center Contracted [320127]	$109	375%
Imagine 360 Contracted [320494]	$109	375%
Insurance System Inc Contracted [320465]	$109	375%
Mercy Benefit Admin Contracted [320251]	$109	375%
Mercy Benefit Admin [20251]	$109	375%
Point C Contracted [320238]	$109	375%
Preferred Health Plan Contracted [320522]	$109	375%
Reflect Health Contracted [320492]	$109	375%
Show-Me Health Administrators Contracted [320483]	$109	375%
Tri State Healthcare Coalition Contracted [320379]	$109	375%
Yuzu Health Contracted [320521]	$109	375%

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 $83.
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 Lincoln 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.