CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Decatur Memorial Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $93
Cash Discount Price: $277
vs. Medicare Baseline: 3.35x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Decatur Memorial Hospital is $93. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $277. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 3.35x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$277

Average discount available for prompt cash payment at this facility.

Insurance Median

$93

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: $277 (999%)

Insurance Median: $93 (335%)

Cash: $277 (999% of Medicare)

Ins. Median: $93 (335% 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 335% of the Medicare baseline (a markup of 235%). 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	$24 - $277	87%
Aetna	$26 - $186	94%
Coventry	$26 - $166	94%
Health Alliance	$26 - $184	94%
Humana	$26 - $180	94%
Medicare (plans)	$26	94%
Tricare	$26 - $27	94%
UnitedHealthcare	$26 - $277	94%
Veterans Administration	$26	94%
Wellcare	$26	94%
Caterpillar	$33	119%
Medicaid / KanCare	$45 - $46	162%
Illinois Workers Compensation	$49 - $68	177%
Commercial Workers Compensation	$64	231%
Hfn	$64 - $208	231%
Mennonite Churches	$119	429%
Plain Church Medical Group	$125	451%
Health Alliance Mh Employee Plan	$127	458%
Cigna	$129	465%
6 Degrees Health	$166	599%
Hopetrust	$166	599%
Hst	$166	599%
Phcs Savility	$180	649%
Phcs Multiplan Ppo	$188	678%
Healthlink	$190	685%
Corvel	$199	718%
Consociate	$205	740%
Liability	$277	999%

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 $277.
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 Decatur Memorial Hospital 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.