CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Mercy Hospital Carthage

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $87
Cash Discount Price: $87
vs. Medicare Baseline: 3.14x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Mercy Hospital Carthage is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 3.14x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$87

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$27.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $27.72 (100%)

Cash / Self-Pay: $87 (314%)

Insurance Median: $87 (314%)

Cash: $87 (314% of Medicare)

Ins. Median: $87 (314% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $27.72 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 314% of the Medicare baseline (a markup of 214%). 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	$22 - $185	79%
Medicaid / KanCare	$22 - $74	79%
Aetna	$24 - $119	87%
Humana	$24 - $40	87%
Medicare (plans)	$26 - $40	94%
Cherokee Nation Health Serv Contracted [320066]	$37	133%
Cigna	$37 - $121	133%
Cross Timbers Hospice [20098]	$37	133%
Dept Of Veteran Affairs Contracted [320106]	$37	133%
Elara Caring Aspire Hospice [20433]	$37	133%
Globalhealth Contracted [320145]	$37	133%
Halo Hcr Inc Hospice Contracted [320432]	$37	133%
Halo Hcr Inc Hospice [20432]	$37	133%
Indian Health Service Contracted [320198]	$37	133%
Kindful Hospice Contracted [320434]	$37	133%
Kindful Hospice [20434]	$37	133%
Medical Associates Health Contracted [320444]	$37	133%
Mercy Hospice Okc [20252]	$37	133%
Mercy Mgd Behavioral Health Contracted [320259]	$37	133%
Pace Of The Ozarks Contracted [320518]	$37	133%
Provider Partners Health Plans Contracted [320450]	$37	133%
Qual Choice Contracted [320325]	$37	133%
Tricare	$37	133%
UnitedHealthcare	$37 - $117	133%
Workers Comp [20426]	$40 - $121	144%
Point C Contracted [320238]	$47 - $121	170%
Health Systems Inc Contracted [320174]	$58	209%
Insurance System Inc Contracted [320465]	$58	209%
Administrative Payor Contracted [320005]	$60	216%
Centivo Contracted [320505]	$62	224%
Healthscope Contracted [320182]	$70	253%
Ambetter / Centene	$74	267%
Home State Health Plan Contracted [320187]	$74	267%
Novasys Contracted [320285]	$74	267%
Benefit Management Contracted [320052]	$80 - $117	289%
Auxiant Contracted [320462]	$87 - $114	314%
Healthlink Contracted [320179]	$87 - $125	314%
Preferred Health Plan Contracted [320522]	$87	314%
United Medical Resources Contracted [320454]	$111 - $121	400%
90 Degree Benefits Contracted [320436]	$114	411%
Aither Health Contracted [320449]	$114	411%
Ebms Contracted [320493]	$114	411%
Edison Health Solutions Contracted [320502]	$114	411%
Imagine 360 Contracted [320494]	$114	411%
Mercy Benefit Admin Contracted [320251]	$114 - $121	411%
Reflect Health Contracted [320492]	$114	411%
Show-Me Health Administrators Contracted [320483]	$114	411%
Yuzu Health Contracted [320521]	$114	411%
Medica Contracted [320239]	$116	418%
Evolutions Health Care Contracted [320124]	$117	422%
First Health Contracted [320128]	$117	422%
Multiplan Contracted [320270]	$117	422%
Private Health Care Systems Contracted [320320]	$117	422%
American Healthcare Alliance Contracted [320020]	$121	437%
Ppo Plus Contracted [320310]	$121	437%
Usa Managed Care Org Contracted [320429]	$121	437%

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 $87.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97140.

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 97140.
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.