CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Adventist Health Tulare

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $52
Cash Discount Price: $45
vs. Medicare Baseline: 1.88x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Adventist Health Tulare is $52. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 1.88x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $45 (162%)

Insurance Median: $52 (188%)

Cash: $45 (162% of Medicare)

Ins. Median: $52 (188% 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.

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 Shield Mcare	$29	105%
Dignity Mcr Op Only - All Other Plans	$29	105%
Fhcn Pace Mcr Adv - All Plans	$29	105%
Medicare (plans)	$29	105%
Prime Health - All Plans	$29	105%
Tricare	$29	105%
UnitedHealthcare	$29 - $602	105%
Medi-Cal	$32	115%
Dignity Mcal Op Only	$35	126%
Independence Op Only - All Plans	$35	126%
Blue Cross Blue Shield	$37 - $410	133%
Prison Hlthcre - All Plans	$37	133%
Cal Forensic Med Grp - All Plans	$38	137%
Ccipa Medi-Cal - All Plans	$41	148%
Bright Health - All Plans	$42	152%
Healthnet Medi-Cal	$42	152%
Ah Employee Health Plan - All Plans	$52	188%
Incentive Hlth - All Plans	$52	188%
Healthnet Hmo/Ppo - All Other Plans	$77	278%
Cigna	$111	400%
Western Growers - All Plans	$112	404%
Aetna	$133	480%
Network By Design-All Plans	$155	559%
Hs Interplan-All Plans	$160	577%
Multiplan - All Plans	$203	732%
Blue Shield Epn	$256	924%
Blue Shield-All Other Plans	$356	1284%

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 $45.
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 Tulare 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.