CMS Price Transparency Data

Physical therapy (gait training)

Facility: Mercy St Francis Hospital

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $105
Cash Discount Price: $76
vs. Medicare Baseline: 3.61x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Mercy St Francis Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $76. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.61x the Medicare baseline. Located in 100 West Highway 60, Po Box 82, Mountain View, MO.

Cash / Self-Pay

$76

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $76 (262%)

Insurance Median: $105 (361%)

Cash: $76 (262% of Medicare)

Ins. Median: $105 (361% 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 361% of the Medicare baseline (a markup of 261%). 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	$24 - $61	83%
Blue Cross Blue Shield	$28 - $113	96%
Medicare (plans)	$28 - $42	96%
Cigna	$32 - $111	110%
Kindful Hospice Contracted [320434]	$32 - $40	110%
Mercy Mgd Behavioral Health Contracted [320259]	$32 - $40	110%
Acentra Health Contracted [320527]	$32	110%
Medical Associates Health Contracted [320444]	$32 - $40	110%
Cross Timbers Hospice [20098]	$32 - $40	110%
Indian Health Service Contracted [320198]	$32 - $40	110%
UnitedHealthcare	$32 - $111	110%
Dept of Veteran Affairs Contracted [320106]	$32 - $40	110%
Humana	$32 - $105	110%
Qual Choice Contracted [320325]	$32 - $40	110%
Provider Partners Health Plans Contracted [320450]	$32 - $40	110%
Halo Hcr Inc Hospice [20432]	$32 - $40	110%
Cherokee Nation Health Serv Contracted [320066]	$32 - $40	110%
Mercy Hospice Okc [20252]	$32 - $40	110%
Kindful Hospice [20434]	$32 - $40	110%
Halo Hcr Inc Hospice Contracted [320432]	$32 - $40	110%
Elara Caring Aspire Hospice [20433]	$32 - $40	110%
Aetna	$32 - $104	110%
Globalhealth Contracted [320145]	$32 - $40	110%
Pace of the Ozarks Contracted [320518]	$32 - $40	110%
Healthscope Contracted [320182]	$40 - $53	138%
Tricare	$40	138%
Administrative Payor Contracted [320005]	$53	182%
Centivo Contracted [320505]	$53 - $68	182%
Novasys Contracted [320285]	$61	210%
Ambetter / Centene	$61	210%
Home State Health Plan Contracted [320187]	$61	210%
Healthlink Contracted [320179]	$76 - $111	262%
Preferred Health Plan Contracted [320522]	$76	262%
Workers Comp [20426]	$94 - $99	323%
United Medical Resources Contracted [320454]	$105 - $109	361%
Point C Contracted [320238]	$105 - $111	361%
Mercy Benefit Admin Contracted [320251]	$105 - $111	361%
Auxiant Contracted [320462]	$105 - $111	361%
Edison Health Solutions Contracted [320502]	$111	382%
Ebms Contracted [320493]	$111	382%
Show-Me Health Administrators Contracted [320483]	$111	382%
Benefit Management Contracted [320052]	$111	382%
Reflect Health Contracted [320492]	$111	382%
Medica Contracted [320239]	$111	382%
USA Managed Care Org Contracted [320429]	$111	382%
Multiplan Contracted [320270]	$111	382%
90 Degree Benefits Contracted [320436]	$111	382%
Insurance System Inc Contracted [320465]	$111	382%
Point C [20238]	$111	382%
Health Systems Inc Contracted [320174]	$111	382%
Yuzu Health Contracted [320521]	$111	382%
First Health Contracted [320128]	$111	382%
Aither Health Contracted [320449]	$111	382%
Imagine 360 Contracted [320494]	$111	382%
Private Health Care Systems Contracted [320320]	$111	382%
Evolutions Health Care Contracted [320124]	$111	382%

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 $76.
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 St Francis 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.