CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Mercy Hospital Carthage

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $94
Cash Discount Price: $94
vs. Medicare Baseline: 2.87x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Mercy Hospital Carthage is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.87x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $94 (287%)

Insurance Median: $94 (287%)

Cash: $94 (287% of Medicare)

Ins. Median: $94 (287% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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 287% of the Medicare baseline (a markup of 187%). 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 (%)

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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	$27 - $185	82%
Medicaid / KanCare	$27 - $80	82%
Aetna	$30 - $129	92%
Humana	$30 - $44	92%
Medicare (plans)	$31 - $43	95%
Cherokee Nation Health Serv Contracted [320066]	$40	122%
Cigna	$40 - $130	122%
Cross Timbers Hospice [20098]	$40	122%
Dept Of Veteran Affairs Contracted [320106]	$40	122%
Elara Caring Aspire Hospice [20433]	$40	122%
Globalhealth Contracted [320145]	$40	122%
Halo Hcr Inc Hospice Contracted [320432]	$40	122%
Halo Hcr Inc Hospice [20432]	$40	122%
Indian Health Service Contracted [320198]	$40	122%
Kindful Hospice Contracted [320434]	$40	122%
Kindful Hospice [20434]	$40	122%
Medical Associates Health Contracted [320444]	$40	122%
Mercy Hospice Okc [20252]	$40	122%
Mercy Mgd Behavioral Health Contracted [320259]	$40	122%
Pace Of The Ozarks Contracted [320518]	$40	122%
Provider Partners Health Plans Contracted [320450]	$40	122%
Qual Choice Contracted [320325]	$40	122%
Tricare	$40	122%
UnitedHealthcare	$40 - $126	122%
Workers Comp [20426]	$40 - $130	122%
Point C Contracted [320238]	$51 - $130	156%
Health Systems Inc Contracted [320174]	$62	189%
Insurance System Inc Contracted [320465]	$62	189%
Administrative Payor Contracted [320005]	$65	199%
Centivo Contracted [320505]	$67	205%
Healthscope Contracted [320182]	$76	232%
Ambetter / Centene	$80	244%
Home State Health Plan Contracted [320187]	$80	244%
Novasys Contracted [320285]	$80	244%
Benefit Management Contracted [320052]	$87 - $126	266%
Auxiant Contracted [320462]	$94 - $123	287%
Healthlink Contracted [320179]	$94 - $135	287%
Preferred Health Plan Contracted [320522]	$94	287%
United Medical Resources Contracted [320454]	$120 - $130	367%
90 Degree Benefits Contracted [320436]	$123	376%
Aither Health Contracted [320449]	$123	376%
Ebms Contracted [320493]	$123	376%
Edison Health Solutions Contracted [320502]	$123	376%
Imagine 360 Contracted [320494]	$123	376%
Mercy Benefit Admin Contracted [320251]	$123 - $130	376%
Reflect Health Contracted [320492]	$123	376%
Show-Me Health Administrators Contracted [320483]	$123	376%
Yuzu Health Contracted [320521]	$123	376%
Evolutions Health Care Contracted [320124]	$126	385%
First Health Contracted [320128]	$126	385%
Medica Contracted [320239]	$126	385%
Multiplan Contracted [320270]	$126	385%
Private Health Care Systems Contracted [320320]	$126	385%
American Healthcare Alliance Contracted [320020]	$130	397%
Ppo Plus Contracted [320310]	$130	397%
Usa Managed Care Org Contracted [320429]	$130	397%

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 $94.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

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 97112.
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.