CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Modoc Medical Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $56
Cash Discount Price: $61
vs. Medicare Baseline: 2.02x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Modoc Medical Center is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 2.02x the Medicare baseline. Located in 1111 N Nagle Street, Alturas, CA.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$56

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: $61 (220%)

Insurance Median: $56 (202%)

Cash: $61 (220% of Medicare)

Ins. Median: $56 (202% 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 202% of the Medicare baseline (a markup of 102%). 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
Multiplan Wc	$28	101%
Integrated Hp Wc	$29	105%
Ntwrks By Design Wc - All Plans	$29	105%
Adv Med Mgmt - All Plans	$32	115%
Medi-Cal	$32	115%
Medi-Cal 7/1/24	$32	115%
Blue Shield Mcr Adv	$33	119%
Blue Shield Va	$33	119%
UnitedHealthcare	$33 - $58	119%
Healthnet Mcr Adv	$35	126%
Tricare	$35	126%
Blue Cross Blue Shield	$50 - $56	180%
Blue Shield Exch	$50	180%
Blue Shield Comm - All Other Plans	$56	202%
Carelon - All Plans	$56	202%
Aetna	$58	209%
Corvel - All Plans	$58	209%
Coventry/First Health - All Plans	$58	209%
Galaxy Health - All Plans	$58	209%
Healthnet Comm - All Other Plans	$58	209%
Hmn - All Plans	$58	209%
Integrated Hp - All Other Plans	$58	209%
Interplan - All Plans	$58	209%
Multiplan - All Other Plans	$58	209%
Superior Ca Ppo - All Plans	$58	209%
Partnership Hp - All Plans	$61	220%

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 $61.
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 Modoc 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.