CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Southcoast Hospitals Group

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $64
Cash Discount Price: $77
vs. Medicare Baseline: 2.31x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Southcoast Hospitals Group is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $77. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 2.31x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$77

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $77 (278%)

Insurance Median: $64 (231%)

Cash: $77 (278% of Medicare)

Ins. Median: $64 (231% 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 231% of the Medicare baseline (a markup of 131%). 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	$30 - $204	108%
UnitedHealthcare	$30 - $183	108%
Tufts Senior Care Options [1010315]	$30	108%
Evercare [1010304]	$30	108%
Medicare (plans)	$30 - $38	108%
Aetna	$30 - $116	108%
Wellsense Health Plan Senior Care Options [1020208	$31	112%
Commonwealth Care Alliance [1080501]	$31	112%
Eternal Health [1010322]	$33	119%
Wellsense Health Plan Clarity Connectorcare & Meta	$33	119%
Fallon [1000114]	$42	152%
Tufts [1010701]	$64	231%
Wellsense Health Plan [1010202]	$78	281%
Wellpoint [1000102]	$80	289%
Mass General Brigham Health Plan Connectorcare [10	$86	310%
Mass General Brigham Health Plan Commercial [10122	$86	310%
Tufts Health Public Plans [1010213]	$90 - $412	325%
Group Insurance Service Center [1013001]	$92	332%
Priority Health [1015001]	$92	332%
Innovative Health Plan [1025001]	$92	332%
PHCS [1000125]	$99	357%
Cigna	$101	364%
First Health [1000130]	$116	418%
Harvard Pilgrim [1010602]	$127 - $236	458%

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 $77.
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 Southcoast Hospitals Group 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.