CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: St Louis Childrens Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $127
Cash Discount Price: $107
vs. Medicare Baseline: 4.58x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at St Louis Childrens Hospital is $127. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $107. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 4.58x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$107

Average discount available for prompt cash payment at this facility.

Insurance Median

$127

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: $107 (386%)

Insurance Median: $127 (458%)

Cash: $107 (386% of Medicare)

Ins. Median: $127 (458% 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 458% of the Medicare baseline (a markup of 358%). 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	$27 - $141	97%
Blue Cross Blue Shield	$27 - $151	97%
Essence Healthcare [221]	$27	97%
Humana	$27 - $133	97%
UnitedHealthcare	$27 - $132	97%
Cox Health [757]	$28	101%
Medica [662]	$28	101%
Healthlink [225]	$86 - $134	310%
Cigna	$88 - $97	317%
Consociate [478]	$96	346%
Sarah Bush Lincoln [636]	$96	346%
Apwu Health Plan [216]	$97	350%
Nalc Health Benefit Plan [242]	$97	350%
Priority Health [648]	$97	350%
Cox Health Systems Insurance Company [220]	$98 - $132	354%
Allied Benefits [498]	$103 - $141	372%
Hope Trust [806]	$103	372%
Med-Pay [480]	$116 - $134	418%
Unicare [568]	$116 - $134	418%
Health Alliance [224]	$125	451%
Healthscope Benefits [258]	$127 - $142	458%
First Health Commercial [734]	$132	476%
Beechstreet [551]	$134	483%
Detego Health [868]	$134	483%
Health Systems Inc [620]	$134	483%
Healthcare Sol Mercy [609]	$134	483%
Multiplan Commercial [737]	$134	483%
Multiplan [240]	$134	483%
Phcs [244]	$134 - $142	483%
Preferred Health Professionals [561]	$134	483%
Coresource [497]	$141	509%
Fmh Benefit Service Inc [222]	$141	509%
Mail Handlers [495]	$141	509%
Medica [661]	$142	512%
Hfn [563]	$151	545%

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 $107.
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 St Louis Childrens 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.