CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Saint Joseph Regional Medical Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97140
  • Insurance Median: $130
  • Cash Discount Price: $141
  • vs. Medicare Baseline: 4.69x Medicare
The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Saint Joseph Regional Medical Center is $130. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $141. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 4.69x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$141

Average discount available for prompt cash payment at this facility.

Insurance Median
$130

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: $141 (509%)
Insurance Median: $130 (469%)
Cash: $141 (509% of Medicare)
Ins. Median: $130 (469% 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 469% of the Medicare baseline (a markup of 369%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Aetna $15 - $141 54%
Blue Cross Blue Shield $15 - $186 54%
Medicaid / KanCare $15 - $186 54%
UnitedHealthcare $15 - $186 54%
Medicare (plans) $27 97%
Meridian Complete $27 97%
Pace-Trinity Health $27 97%
County Coroner $28 101%
Provider Partners Health Plan Of Indiana $29 105%
Auxiant $40 - $180 144%
Physicians Health Plan Northern Indiana Health Insurance $40 - $81 144%
St Joseph County Hlth Dpt $40 144%
Caresource $41 148%
Siho Insurance Services $43 155%
Key Benefit Administrator $48 - $135 173%
Allied Benefit Systems $51 - $141 184%
Blue Benefit Administrators Of Massachusetts $53 191%
Blue Care Network $53 191%
Blue Distinction Transplant $53 191%
Blue Shield - Ca $53 191%
Blue Shield - Id (Regence) $53 191%
Blue Shield - Ny Highmark Northeastern $53 191%
Blue Shield - Ny Highmark Western $53 191%
Blue Shield - Pa (Highmark) $53 191%
Blue Shield - Wa (Regence) $53 191%
Hospice Of Marshall County $56 202%
Hospice Of St Joseph County $56 202%
Custom Design Benefits $57 206%
Plain Church Group $59 213%
Notre Dame Athletic Association $119 429%
Wc Notre Dame $119 429%
Luminare Health (Detroit) $124 - $130 447%
Encore Health $129 - $135 465%
Ameriben $130 469%
Indiana Criminal Justice Inst $135 487%
Western & Southern Financial Group $135 487%
Geha $138 498%
Healthscope $138 498%
Student Insurance Cma $138 498%
Cigna $139 501%
Group Administrators $139 501%
Health Partners $139 501%
Mvp $139 501%
Prairie States $139 501%
Priority Health $139 501%
Professional Benefit Administrators $139 501%
Sagamore Health Network $139 - $161 501%
Sisco Benefits $139 501%
Unified Group Services $139 501%
Asr Health Benefits $141 509%
Christian Brother Services $141 509%
Employee Benefit Management $141 509%
Medical Mutual $141 509%
Meritain $141 509%
Preferred One $141 509%
Rural Carrier Health Benefit Plan $141 509%
Webtpa $141 509%
Goshen Preferred Network $167 - $187 602%
Christian Brothers Holy Cross $174 628%
Signature Care $174 628%
Managed Health Services - Indiana $186 671%
Mdwise $186 671%
Bankers Life Casualty $217 783%
Bureau Of Disability $217 783%
Wc Align Network $217 783%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals