CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Pinckneyville Community Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $136
Cash Discount Price: $179
vs. Medicare Baseline: 4.91x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Pinckneyville Community Hospital is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $179. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 4.91x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$179

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $179 (646%)

Insurance Median: $136 (491%)

Cash: $179 (646% of Medicare)

Ins. Median: $136 (491% 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 491% of the Medicare baseline (a markup of 391%). 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
Humana	$60 - $77	216%
Umwa Mcr Adv - All Plans	$60 - $77	216%
UnitedHealthcare	$60 - $170	216%
Wellcare Mcr Adv - All Plans	$60 - $77	216%
Aetna	$61 - $197	220%
Blue Cross Blue Shield	$117 - $197	422%
Healthlink Hmo	$127 - $162	458%
Phcs - All Other Plans	$133 - $170	480%
Cigna	$134 - $171	483%
Healthlink Ppo - All Other Plans	$134 - $171	483%
Healthlink Work Comp	$134 - $171	483%
Phcs Savility	$138 - $176	498%
Multiplan - All Plans	$146 - $186	527%
Ambetter / Centene	$197	711%
Medicaid / KanCare	$197	711%

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 $179.
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 Pinckneyville Community 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.