CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Adventist Health Clearlake

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $146
Cash Discount Price: $62
vs. Medicare Baseline: 5.27x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Adventist Health Clearlake is $146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 5.27x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$146

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: $62 (224%)

Insurance Median: $146 (527%)

Cash: $62 (224% of Medicare)

Ins. Median: $146 (527% 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 527% of the Medicare baseline (a markup of 427%). 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
Bc Managed Mcal	$32	115%
Medi-Cal	$32	115%
Blue Shield Mcr Adv	$36	130%
Kaiser Mcr Adv	$36	130%
Tricare	$36	130%
Blue Cross Blue Shield	$38 - $543	137%
UnitedHealthcare	$40 - $144	144%
Ah Employee Health Plan - All Plans	$73	263%
Aetna	$129	465%
Western Growers- All Plans	$130	469%
First Health- All Plans	$138	498%
Healthnet- All Plans	$142	512%
Foundation- All Plans	$147	530%
Health Mgmt Network- All Plans	$147	530%
Humana	$147	530%
Phcs- All Plans	$147	530%
Cigna	$156	563%
Interplan- All Plans	$156	563%
Kaiser- All Other Plans	$156	563%
Three Rivers Provider Network- All Plans	$156	563%
Partnership Mcal - All Plans	$285	1028%
Blue Shield Epn - All Other Plans	$326	1176%
Blue Shield Non-Epn	$333	1201%

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 $62.
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 Clearlake 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.