CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Adventist Health and Rideout

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $189
Cash Discount Price: $57
vs. Medicare Baseline: 6.82x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Adventist Health and Rideout is $189. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 6.82x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$57

Average discount available for prompt cash payment at this facility.

Insurance Median

$189

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: $57 (206%)

Insurance Median: $189 (682%)

Cash: $57 (206% of Medicare)

Ins. Median: $189 (682% 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 682% of the Medicare baseline (a markup of 582%). 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	$29 - $199	105%
Kaiser Mcr Adv	$29	105%
Tricare	$29	105%
UnitedHealthcare	$29 - $225	105%
Kaiser Mcal	$32	115%
Medi-Cal	$32	115%
Bc Mcal	$34	123%
Ca Health And Wellness- All Plans	$40	144%
Celtic Mcaid-All Plans	$40	144%
Ah Employee Health Plan - All Plans	$52	188%
Healthnet Mcal	$52	188%
Aetna	$183	660%
Healthnet Comm-All Other Plans	$189	682%
Kaiser-All Other Plans	$197	711%
Blue Shield Uc Care Members	$207	747%
Cigna	$221	797%
First Health-All Plans	$227	819%
Phcs-All Plans	$228	823%
Interplan-All Plans	$233	841%
Blue Shield-All Other Plans	$246	887%
Multiplan-All Plans	$246	887%
Partnership Hp Mcal -All Plans	$427	1540%

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 $57.
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 Adventist Health and Rideout 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.