CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Tri Valley Health System

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $97
Cash Discount Price: $147
vs. Medicare Baseline: 3.50x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Tri Valley Health System is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $147. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 3.50x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$147

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $147 (530%)

Insurance Median: $97 (350%)

Cash: $147 (530% of Medicare)

Ins. Median: $97 (350% 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 350% of the Medicare baseline (a markup of 250%). 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	$55 - $184	198%
Humana	$55 - $89	198%
Medica Mcr Adv	$55 - $89	198%
Medica Prime Sol	$55 - $89	198%
Tricare	$55 - $89	198%
Wellcare Mcr Adv - All Plans	$55 - $89	198%
Great Plains Mcr Adv - All Plans	$58 - $93	209%
Healthy Blue Mcaid - All Plans	$60 - $97	216%
Molina Mcaid - All Plans	$60 - $97	216%
Nebraska Total Care-All Plans	$60 - $97	216%
UnitedHealthcare	$60 - $194	216%
Amerigroup Mcaid - All Plans	$61 - $99	220%
Medica Chi Aco - All Other Plans	$112 - $182	404%
Medica Chi Open Access	$112 - $182	404%
Medica Ifb Aco	$112 - $182	404%
Medica Ifb Open Access	$112 - $182	404%
Midlands Choice-All Plans	$112 - $182	404%
Aetna	$122 - $198	440%
Multiplan-All Plans	$122 - $198	440%

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 $147.
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 Tri Valley Health System 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.