CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercy Hospital Carthage

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $81
Cash Discount Price: $81
vs. Medicare Baseline: 2.79x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Hospital Carthage is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $81. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.79x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$81

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

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: $81 (279%)

Insurance Median: $81 (279%)

Cash: $81 (279% of Medicare)

Ins. Median: $81 (279% 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 279% of the Medicare baseline (a markup of 179%). 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
Blue Cross Blue Shield	$24 - $185	83%
Medicaid / KanCare	$24 - $68	83%
Aetna	$26 - $110	89%
Humana	$26 - $37	89%
Medicare (plans)	$28 - $37	96%
Cherokee Nation Health Serv Contracted [320066]	$34	117%
Cigna	$34 - $112	117%
Cross Timbers Hospice [20098]	$34	117%
Dept Of Veteran Affairs Contracted [320106]	$34	117%
Elara Caring Aspire Hospice [20433]	$34	117%
Globalhealth Contracted [320145]	$34	117%
Halo Hcr Inc Hospice Contracted [320432]	$34	117%
Halo Hcr Inc Hospice [20432]	$34	117%
Indian Health Service Contracted [320198]	$34	117%
Kindful Hospice Contracted [320434]	$34	117%
Kindful Hospice [20434]	$34	117%
Medical Associates Health Contracted [320444]	$34	117%
Mercy Hospice Okc [20252]	$34	117%
Mercy Mgd Behavioral Health Contracted [320259]	$34	117%
Pace Of The Ozarks Contracted [320518]	$34	117%
Provider Partners Health Plans Contracted [320450]	$34	117%
Qual Choice Contracted [320325]	$34	117%
Tricare	$34	117%
UnitedHealthcare	$34 - $108	117%
Workers Comp [20426]	$40 - $112	138%
Point C Contracted [320238]	$43 - $112	148%
Health Systems Inc Contracted [320174]	$53	182%
Insurance System Inc Contracted [320465]	$53	182%
Administrative Payor Contracted [320005]	$56	193%
Centivo Contracted [320505]	$57	196%
Healthscope Contracted [320182]	$65	224%
Ambetter / Centene	$68	234%
Home State Health Plan Contracted [320187]	$68	234%
Novasys Contracted [320285]	$68	234%
Benefit Management Contracted [320052]	$74 - $108	255%
Auxiant Contracted [320462]	$81 - $105	279%
Healthlink Contracted [320179]	$81 - $115	279%
Preferred Health Plan Contracted [320522]	$81	279%
United Medical Resources Contracted [320454]	$103 - $112	354%
90 Degree Benefits Contracted [320436]	$105	361%
Aither Health Contracted [320449]	$105	361%
Ebms Contracted [320493]	$105	361%
Edison Health Solutions Contracted [320502]	$105	361%
Imagine 360 Contracted [320494]	$105	361%
Mercy Benefit Admin Contracted [320251]	$105 - $112	361%
Reflect Health Contracted [320492]	$105	361%
Show-Me Health Administrators Contracted [320483]	$105	361%
Yuzu Health Contracted [320521]	$105	361%
Medica Contracted [320239]	$107	368%
Evolutions Health Care Contracted [320124]	$108	372%
First Health Contracted [320128]	$108	372%
Multiplan Contracted [320270]	$108	372%
Private Health Care Systems Contracted [320320]	$108	372%
American Healthcare Alliance Contracted [320020]	$112	385%
Ppo Plus Contracted [320310]	$112	385%
Usa Managed Care Org Contracted [320429]	$112	385%

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 $81.
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 Carthage 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.