CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: City of Hope National Medical Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $117
Cash Discount Price: $133
vs. Medicare Baseline: 4.22x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at City of Hope National Medical Center is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 4.22x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$133

Average discount available for prompt cash payment at this facility.

Insurance Median

$117

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: $133 (480%)

Insurance Median: $117 (422%)

Cash: $133 (480% of Medicare)

Ins. Median: $117 (422% 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 422% of the Medicare baseline (a markup of 322%). 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
Health Net	$22 - $171	79%
Heritage Provider Network	$28 - $102	101%
Cal Optima	$30 - $31	108%
Inland Empire	$38 - $117	137%
Prime Healthcare Keenan	$53 - $140	191%
Blue Cross Blue Shield	$60 - $292	216%
UnitedHealthcare	$67 - $292	242%
Blue Shield	$71 - $292	256%
Blue Shield Promise	$84 - $102	303%
Cencal	$96 - $117	346%
La Care Health	$96 - $117	346%
Kaiser	$108 - $131	390%
Aetna	$120 - $146	433%
Gold Coast	$120 - $146	433%
Molina	$120 - $190	433%
Cigna	$129 - $157	465%
Facey	$132 - $161	476%
Healthcare Partners	$139 - $169	501%
St. Joseph Heritage	$144 - $175	519%
Primecare Medical Network	$156 - $190	563%
First Health	$185 - $225	667%
Phcs Multiplan	$216 - $263	779%
Blue Shield Covca	$238	859%

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 $133.
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 City of Hope National Medical Center 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.