CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercy Hospital Logan County

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $77
Cash Discount Price: $83
vs. Medicare Baseline: 2.65x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy Hospital Logan County is $77. 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 2.65x the Medicare baseline. Located in 200 S Academy Rd, Guthrie, OK.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $77 (265%)

Cash: $83 (286% of Medicare)

Ins. Median: $77 (265% 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 265% of the Medicare baseline (a markup of 165%). 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
Aetna	$26 - $75	89%
Humana	$26 - $102	89%
Medicaid / KanCare	$26 - $38	89%
Tricare	$32	110%
Blue Cross Blue Shield	$33 - $61	114%
Cherokee Nation Health Serv Contracted [320066]	$33	114%
Cross Timbers Hospice [20098]	$33	114%
Dept Of Veteran Affairs Contracted [320106]	$33	114%
Elara Caring Aspire Hospice Contracted [320433]	$33	114%
Elara Caring Aspire Hospice [20433]	$33	114%
Globalhealth Contracted [320145]	$33	114%
Halo Hcr Inc Hospice Contracted [320432]	$33	114%
Halo Hcr Inc Hospice [20432]	$33	114%
Independent Health [20197]	$33	114%
Indian Health Service Contracted [320198]	$33	114%
Kindful Hospice Contracted [320434]	$33	114%
Kindful Hospice [20434]	$33	114%
Medical Associates Health [20444]	$33	114%
Medicare (plans)	$33 - $64	114%
Mercy Hospice Okc [20252]	$33	114%
Provider Partners Health Plans Contracted [320450]	$33	114%
Qual Choice Contracted [320325]	$33	114%
Tribute Health Plan Mcr Contracted [320338]	$33	114%
UnitedHealthcare	$33 - $90	114%
Cigna	$34 - $109	117%
Ambetter / Centene	$38	131%
Home State Health Plan Contracted [320187]	$38	131%
Novasys Contracted [320285]	$38	131%
Health Choice Contracted [320166]	$45	155%
Webtpa Contracted [320417]	$54	186%
Medica Contracted [320239]	$64	220%
Aither Health Contracted [320449]	$77 - $109	265%
Auxiant Contracted [320462]	$77 - $109	265%
Federal Medical Center Contracted [320127]	$77	265%
Healthlink Contracted [320179]	$77 - $109	265%
Healthscope Contracted [320182]	$77	265%
Mercy Benefit Admin Contracted [320251]	$77 - $109	265%
Point C Contracted [320238]	$77	265%
Preferred Health Plan Contracted [320522]	$77	265%
Quik Trip Contracted [320447]	$77	265%
Show-Me Health Administrators Contracted [320483]	$77	265%
United Medical Resources Contracted [320454]	$77 - $90	265%
Community Care Contracted [320080]	$90	310%
Osma Health Contracted [320292]	$90	310%
United Behavioral Health Contracted [320390]	$90	310%
Benefit Management Contracted [320052]	$96 - $115	330%
Globalhealth Contracted [320144]	$96	330%
Healthcare Highways Plus Contracted [320175]	$96	330%
Private Health Care Systems Contracted [320320]	$96 - $102	330%
First Health Contracted [320128]	$100	344%
Multiplan Contracted [320270]	$102 - $115	351%
Ebms Contracted [320493]	$109	375%
Imagine 360 Contracted [320494]	$109	375%
Preferred Community Choice Contracted [320311]	$109	375%
Reflect Health Contracted [320492]	$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 Logan County 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.