CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercy Health Rehabilitation Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $150
Cash Discount Price: $150
vs. Medicare Baseline: 5.16x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Health Rehabilitation Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.16x the Medicare baseline. Located in 3180 Belmont Ave, Youngstown, OH.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $150 (516%)

Insurance Median: $150 (516%)

Cash: $150 (516% of Medicare)

Ins. Median: $150 (516% 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 516% of the Medicare baseline (a markup of 416%). 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
Medical Mutual Nas	$57 - $105	196%
Aultcare	$70 - $130	241%
Multiplan	$87 - $160	299%
Aetna	$104 - $191	358%
Ambetter / Centene	$104 - $191	358%
Blue Cross Blue Shield	$104 - $191	358%
Caresource Exchange	$104 - $191	358%
Cigna	$104 - $191	358%
Devoted	$104 - $191	358%
Highmark Ppo Commercial	$104 - $191	358%
Highmark Ppo Exchange	$104 - $191	358%
Humana	$104 - $191	358%
Medicaid / KanCare	$104 - $191	358%
Medical Mutual Exchange	$104 - $191	358%
Medical Mutual Medflex	$104 - $191	358%
Medical Mutual New Biz	$104 - $191	358%
Medical Mutual Supermed Commercial	$104 - $191	358%
Medical Mutual Traditional Commercial	$104 - $191	358%
Medicare (plans)	$104 - $191	358%
Molina Exchange	$104 - $191	358%
UnitedHealthcare	$104 - $191	358%
Upmc	$104 - $191	358%

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 $150.
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 Health Rehabilitation Hospital 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.