CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Mercy Hospital Lincoln

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $100
Cash Discount Price: $86
vs. Medicare Baseline: 3.06x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Mercy Hospital Lincoln is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.06x the Medicare baseline. Located in 1000 East Cherry Street, Troy, MO.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $86 (263%)

Insurance Median: $100 (306%)

Cash: $86 (263% of Medicare)

Ins. Median: $100 (306% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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 306% of the Medicare baseline (a markup of 206%). 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	$9 - $61	27%
Aetna	$20 - $87	61%
Tricare	$28	86%
Medicare (plans)	$29 - $133	89%
UnitedHealthcare	$29 - $88	89%
American Health Advantage Of Mo Mcr [10473]	$31	95%
Blue Cross Blue Shield	$31 - $202	95%
Cherokee Nation Health Serv Contracted [320066]	$31	95%
Cross Timbers Hospice [20098]	$31	95%
Dept Of Veteran Affairs Contracted [320106]	$31	95%
Elara Caring Aspire Hospice Contracted [320433]	$31	95%
Elara Caring Aspire Hospice [20433]	$31	95%
Globalhealth Contracted [320145]	$31	95%
Halo Hcr Inc Hospice Contracted [320432]	$31	95%
Halo Hcr Inc Hospice [20432]	$31	95%
Humana	$31 - $120	95%
Indian Health Service Contracted [320198]	$31	95%
Kindful Hospice Contracted [320434]	$31	95%
Kindful Hospice [20434]	$31	95%
Mercy Hospice Okc [20252]	$31	95%
Pace Of The Ozarks Contracted [320518]	$31	95%
Provider Partners Health Plans Contracted [320450]	$31	95%
Qual Choice Contracted [320325]	$31	95%
Cigna	$33 - $110	101%
Centivo Contracted [320505]	$48	147%
Medica Contracted [320239]	$56	171%
Ambetter / Centene	$61	186%
Home State Health Plan Contracted [320187]	$61	186%
Novasys Contracted [320285]	$61	186%
Hope Trust Contracted [320488]	$66	202%
Health Choices Contracted [320448]	$80	244%
Health Choices [20448]	$80	244%
Medical Associates Health Contracted [320444]	$80	244%
First Health Contracted [320128]	$87 - $100	266%
United Medical Resources Contracted [320454]	$88	269%
Mercy Mgd Behavioral Health Contracted [320259]	$100	306%
Multiplan Contracted [320270]	$100	306%
Private Health Care Systems Contracted [320320]	$100	306%
Workers Comp [20426]	$100 - $106	306%
Healthlink Contracted [320179]	$108 - $118	330%
Aither Health Contracted [320449]	$113	345%
Aither Health [20449]	$113	345%
Auxiant Contracted [320462]	$113	345%
Ebms Contracted [320493]	$113	345%
Edison Health Solutions Contracted [320502]	$113	345%
Federal Medical Center Contracted [320127]	$113	345%
Imagine 360 Contracted [320494]	$113	345%
Insurance System Inc Contracted [320465]	$113	345%
Mercy Benefit Admin Contracted [320251]	$113	345%
Mercy Benefit Admin [20251]	$113	345%
Point C Contracted [320238]	$113	345%
Preferred Health Plan Contracted [320522]	$113	345%
Reflect Health Contracted [320492]	$113	345%
Show-Me Health Administrators Contracted [320483]	$113	345%
Tri State Healthcare Coalition Contracted [320379]	$113	345%
Yuzu Health Contracted [320521]	$113	345%

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 $86.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

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 97112.
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.