CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Grossmont Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $141
Cash Discount Price: $167
vs. Medicare Baseline: 5.09x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Grossmont Hospital is $141. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $167. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 5.09x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$167

Average discount available for prompt cash payment at this facility.

Insurance Median

$141

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: $167 (602%)

Insurance Median: $141 (509%)

Cash: $167 (602% of Medicare)

Ins. Median: $141 (509% 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 509% of the Medicare baseline (a markup of 409%). 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
Indian Health Council	$5 - $93	18%
Cigna	$12 - $147	43%
Aetna	$31 - $178	112%
Blue Cross Blue Shield	$33 - $1,252	119%
County Medical Services	$39 - $62	141%
Blue Shield	$66 - $218	238%
UnitedHealthcare	$66 - $166	238%
Molina	$67 - $182	242%
Health Net	$68 - $218	245%
San Diego Pace	$75	271%
Humana	$93	335%
Community Health Group	$106 - $153	382%
Multiplan	$107 - $155	386%
California Health And Wellness	$135	487%
Managed Health Network	$138 - $153	498%
Interplan	$142 - $626	512%
Epic Americas	$147 - $171	530%
Medi-Cal	$147 - $155	530%
Allianz Global Assistance	$153	552%
Kaiser	$178	642%

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 $167.
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 Grossmont Hospital 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.