CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Woodlawn Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $138
Cash Discount Price: $141
vs. Medicare Baseline: 4.98x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Woodlawn Hospital is $138. 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 4.98x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$141

Average discount available for prompt cash payment at this facility.

Insurance Median

$138

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: $138 (498%)

Cash: $141 (509% of Medicare)

Ins. Median: $138 (498% 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 498% of the Medicare baseline (a markup of 398%). 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
Aetna	$41 - $179	148%
Blue Cross Blue Shield	$41 - $188	148%
Caresource Mcaid Hip	$41	148%
Caresource Mcr Adv	$41	148%
Humana	$41 - $146	148%
Mdwise Mcaid Excel Hip	$41	148%
Mhs Exch Mrktplce-All Other Plans	$41	148%
Mhs Mcaid Hip	$41	148%
UnitedHealthcare	$41 - $188	148%
Mhs Mcr Adv	$42	152%
Caresource Exch - All Other Plans	$54	195%
Ambetter / Centene	$55	198%
Partners Direct Health-All Plans	$128	462%
Cigna	$135 - $160	487%
Parkview Health Plans-All Plans	$141	509%
Sagamore All Other Grps - All Other Plans	$158	570%
Encore Comm-All Plans	$160	577%
Phcs/Multiplan-All Plans	$175	631%
Community Health Alliance-All Plans	$179	646%
Caresource Mcaid Hww	$188	678%
Mhs Mcaid Hcc	$188	678%
Mhs Mcaid Hhw	$188	678%

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 $141.
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 Woodlawn 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.