CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercy Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $86
Cash Discount Price: $137
vs. Medicare Baseline: 2.96x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Medical Center is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $137. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.96x the Medicare baseline. Located in 1320 Mercy Drive Nw, Canton, OH.

Cash / Self-Pay

$137

Average discount available for prompt cash payment at this facility.

Insurance Median

$86

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: $137 (471%)

Insurance Median: $86 (296%)

Cash: $137 (471% of Medicare)

Ins. Median: $86 (296% 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 296% of the Medicare baseline (a markup of 196%). 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
Summacare	$25 - $70	86%
United	$25 - $238	86%
Blue Cross Blue Shield	$26 - $135	89%
Buckeye	$26	89%
Caresource	$26	89%
Molina	$26	89%
Amerihealth	$28	96%
The Health Plan	$33 - $211	114%
Aetna	$37 - $211	127%
Humana	$37	127%
Cigna	$38 - $110	131%
Communicare	$39	134%
Mmo	$39 - $81	134%
Perennial Health	$40	138%
Zing Health	$63	217%
Oscar	$64 - $81	220%
Cc Ehp	$84 - $85	289%
Aultcare	$87	299%
Amish Community Aid Plan	$95 - $106	327%
Ohcp	$103	354%
Immergrun	$106	365%
Omas	$106	365%
Ohio Healthy	$114	392%
Php	$127	437%
Phphi	$127	437%
Gms	$148	509%
Medical Benefit Corp	$148	509%
Consociate Health	$158	544%
Frontpath	$190	654%
Managed Care Services	$190	654%
Multiplan	$190	654%
Tertiary Care Network	$190	654%

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 $137.
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 Medical Center 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.