CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Hermann Area District Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $58
Cash Discount Price: $62
vs. Medicare Baseline: 2.09x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Hermann Area District Hospital is $58. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 2.09x the Medicare baseline. Located in 509 W 18Th St, Hermann, MO.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$58

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: $62 (224%)

Insurance Median: $58 (209%)

Cash: $62 (224% of Medicare)

Ins. Median: $58 (209% 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 209% of the Medicare baseline (a markup of 109%). 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
Healthy Blue Mcaid - All Plans	$21	76%
Ambetter / Centene	$22 - $244	79%
Blue Cross Blue Shield	$23 - $153	83%
UnitedHealthcare	$23 - $153	83%
Choicecare Mcr Adv- All Plans	$27 - $46	97%
Tricare	$41 - $137	148%
Healthcare Usa Mcaid- All Plans	$42 - $71	152%
Healthlink Hmo	$42 - $71	152%
American Hlth Mcr Adv- All Plans	$45 - $153	162%
Humana	$45 - $153	162%
Aetna	$46 - $156	166%
Wellcare Mcr Adv - All Plans	$46 - $156	166%
Healthlink Ppo - All Other Plans	$48 - $82	173%
Multiplan/Phcs - All Plans	$48 - $82	173%
Harmony Hp Mcaid- All Plans	$50	180%
Care Partners Mcaid- All Plans	$52	188%
Coventry - All Plans	$54 - $93	195%
Comp Results - All Plans	$58 - $98	209%
Three Rivers - All Plans	$58 - $98	209%
Cigna	$61 - $65	220%

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 $62.
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 Hermann Area District 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.