CMS Price Transparency Data
Physical therapy (manual therapy)
Facility: Trinity Health Muskegon Hospital
Billing Code: 97140 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97140
- Insurance Median: $117
- Cash Discount Price: $101
- vs. Medicare Baseline: 4.22x Medicare
The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Trinity Health Muskegon Hospital is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 4.22x the Medicare baseline. Located in 1500 E Sherman Blvd, Muskegon, MI.
Cash / Self-Pay
$101
Average discount available for prompt cash payment at this facility.
Insurance Median
$117
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: $101 (364%)
Insurance Median: $117 (422%)
Cash: $101 (364% of Medicare)
Ins. Median: $117 (422% 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 422% of the Medicare baseline (a markup of 322%). 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.
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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 | $15 - $76 | 54% |
| Medicaid / KanCare | $15 | 54% |
| Access Health | $19 | 69% |
| Aetna | $26 - $106 | 94% |
| Blue Care Network Advantage | $26 | 94% |
| Medicare (plans) | $26 | 94% |
| Align Senior Care | $27 | 97% |
| Correctional Recovery | $27 | 97% |
| Heartland Hospice | $27 | 97% |
| Hospice Harbor Hospice | $27 | 97% |
| UnitedHealthcare | $28 - $137 | 101% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $30 | 108% |
| Oscar | $34 | 123% |
| Molina Marketplace | $35 | 126% |
| Vitalcore | $41 | 148% |
| Wellpath | $41 | 148% |
| U Of M Health Plan | $42 - $123 | 152% |
| Bcn Domestic | $76 | 274% |
| Blue Benefit Administrators Of Massachusetts | $76 | 274% |
| Blue Care Network | $76 | 274% |
| Blue Distinction Transplant | $76 | 274% |
| Blue Shield - Ca | $76 | 274% |
| Blue Shield - Id (Regence) | $76 | 274% |
| Blue Shield - Ny Highmark Northeastern | $76 | 274% |
| Blue Shield - Ny Highmark Western | $76 | 274% |
| Blue Shield - Pa (Highmark) | $76 | 274% |
| Blue Shield - Wa (Regence) | $76 | 274% |
| Health Choices | $76 - $123 | 274% |
| Kaiser Domestic | $76 | 274% |
| Acs Benefit Services | $81 | 292% |
| Allied Benefit Systems | $81 | 292% |
| Claimchoice Adminstrators | $81 | 292% |
| Consociate | $81 | 292% |
| Cypress Benefit Administrators | $81 | 292% |
| Forest County Potawatomi | $81 | 292% |
| Health Smart | $81 | 292% |
| Healthgram | $81 | 292% |
| Healthscope | $81 | 292% |
| Preferred One | $81 | 292% |
| Secureone Preferred United Plans | $81 | 292% |
| Sisco Benefits | $81 | 292% |
| The Health Plan | $81 | 292% |
| Trustmark Small Business Benefits | $81 | 292% |
| Unified Group Services | $81 | 292% |
| Webtpa | $81 | 292% |
| Asr Health Benefits | $83 | 299% |
| Hap | $83 - $124 | 299% |
| Wc Accident Fund | $83 | 299% |
| Wc Advantage | $83 | 299% |
| Wc Aig | $83 | 299% |
| Wc Allied | $83 | 299% |
| Wc Amerisure | $83 | 299% |
| Wc Amtrust | $83 | 299% |
| Wc Asu Risk Mgt | $83 | 299% |
| Wc Berkley Admin | $83 | 299% |
| Wc Broadspire | $83 | 299% |
| Wc Bunch & Associates | $83 | 299% |
| Wc Ccmsi | $83 | 299% |
| Wc Emc Insurance Company | $83 | 299% |
| Wc Esis | $83 | 299% |
| Wc Fcci | $83 | 299% |
| Wc Federated | $83 | 299% |
| Wc Gallagher Bassett | $83 | 299% |
| Wc Genex Care For Ohio | $83 | 299% |
| Wc Guard Insurance Company | $83 | 299% |
| Wc Hartford | $83 | 299% |
| Wc Liberty Mutual | $83 | 299% |
| Wc Meijers | $83 | 299% |
| Wc Michigan | $83 | 299% |
| Wc Mitchell Frankenmuth | $83 | 299% |
| Wc Pma | $83 | 299% |
| Wc Sedgwick | $83 | 299% |
| Wc Sentry | $83 | 299% |
| Wc Travelers | $83 | 299% |
| Wc Tristar | $83 | 299% |
| Wc Walmart | $83 | 299% |
| Wc Zurich | $83 | 299% |
| Hospice Of Michigan | $86 | 310% |
| Nomi Health | $87 | 314% |
| Varipro | $90 | 325% |
| Caresource | $98 | 354% |
| Cigna | $98 | 354% |
| Priority Health | $102 - $115 | 368% |
| Geha | $106 - $137 | 382% |
| Meritain | $106 | 382% |
| 1199 National Benefit Fund | $117 | 422% |
| Allied National Global Care | $117 | 422% |
| Asrm - Reliance Standard Life Insurance | $117 | 422% |
| Christian Care Ministry | $117 | 422% |
| Dean Health | $117 | 422% |
| Fallon Health | $117 | 422% |
| Family Life Insurance Company | $117 | 422% |
| Ghc Scw | $117 | 422% |
| Group Pension Administrators | $117 | 422% |
| International Benefit Administrators | $117 | 422% |
| Lifetime Benefit Solutions | $117 | 422% |
| Manhattan Life | $117 | 422% |
| Medi Share | $117 | 422% |
| Multiplan | $117 | 422% |
| Mvp | $117 | 422% |
| Pai | $117 | 422% |
| Pan-American Life | $117 | 422% |
| Paramount Hmo | $117 | 422% |
| Phcs | $117 | 422% |
| Trinity Health Share | $117 | 422% |
| Acclaim | $123 | 444% |
| Administrative Concepts | $123 | 444% |
| Allegeant | $123 | 444% |
| Ameriben | $123 | 444% |
| American Family | $123 | 444% |
| American Healthcare Alliance | $123 | 444% |
| American Republic | $123 | 444% |
| Amerihealth | $123 | 444% |
| Aultcare | $123 | 444% |
| Automated Benefit Services | $123 | 444% |
| Auxiant | $123 | 444% |
| Benefit Administrative Systems,Llc | $123 | 444% |
| Boon Chapman | $123 | 444% |
| Cam Administrative Services | $123 | 444% |
| Christian Brother Services | $123 | 444% |
| Christian Brothers Holy Cross | $123 | 444% |
| Comprehensive Benefits | $123 | 444% |
| Continental Life Insurance | $123 | 444% |
| Custom Benefit Administrators | $123 | 444% |
| Employee Benefit Concepts | $123 | 444% |
| Employee Benefit Management | $123 | 444% |
| Enterprise Group Planning | $123 | 444% |
| Freedom Life Insurance Company | $123 | 444% |
| Group Administrators | $123 | 444% |
| Group Marketing Services | $123 | 444% |
| Guardian | $123 | 444% |
| Health America | $123 | 444% |
| Healthez | $123 | 444% |
| Humana | $123 | 444% |
| Insight | $123 | 444% |
| Intercare | $123 | 444% |
| Jfp Benefit Management | $123 | 444% |
| Jp Farley Corporation | $123 | 444% |
| Key Benefit Administrator | $123 | 444% |
| Liberty Union Life Assurance Co | $123 | 444% |
| Lucent Health | $123 | 444% |
| Luminare Health | $123 | 444% |
| Luminare Health (Detroit) | $123 | 444% |
| Medben | $123 | 444% |
| Medcost | $123 | 444% |
| Medical Mutual | $123 | 444% |
| Mutual Health Services | $123 | 444% |
| Mutual Of Omaha | $123 | 444% |
| Ncas | $123 | 444% |
| Nippon Life Ins | $123 | 444% |
| Nova | $123 | 444% |
| Painters Union Insurance Fund | $123 | 444% |
| Physicians Mutual | $123 | 444% |
| Plumbers Local 98 Insurance Fund | $123 | 444% |
| Prairie States | $123 | 444% |
| Primary Physician Care | $123 | 444% |
| Professional Benefit Administrators | $123 | 444% |
| The Loomis Company | $123 | 444% |
| Unicare | $123 | 444% |
| Us Health And Life | $123 | 444% |
| Valenz | $123 | 444% |
| Western & Southern Financial Group | $123 | 444% |
| Wps | $123 | 444% |
| First Health | $128 | 462% |
| Barinet | $156 | 563% |
| Cmh Allegan County | $156 | 563% |
| Cmh Barry County | $156 | 563% |
| Cmh Berrien County | $156 | 563% |
| Cmh Cass County | $156 | 563% |
| Cmh Kalamazoo | $156 | 563% |
| Cmh Kent County | $156 | 563% |
| Cmh Misc | $156 | 563% |
| Cmh Muskegon County | $156 | 563% |
| Cmh North Country | $156 | 563% |
| Cmh Northern Lakes County | $156 | 563% |
| Cmh Ottawa County | $156 | 563% |
| Cmh Van Buren County | $156 | 563% |
| Cmh West Mi County | $156 | 563% |