CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: St Mary's General Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $46
Cash Discount Price: $30
vs. Medicare Baseline: 1.66x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at St Mary's General Hospital is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $30. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 1.66x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$30

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $30 (108%)

Insurance Median: $46 (166%)

Cash: $30 (108% of Medicare)

Ins. Median: $46 (166% 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.

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
Humana	$25	90%
Aetna	$31 - $65	112%
Medicare (plans)	$31	112%
Amerihealth	$31	112%
Wellcare	$31 - $41	112%
Horizon	$31 - $155	112%
Wellpoint Amerigroup	$31	112%
Clover Health	$31	112%
Tricare	$31	112%
UnitedHealthcare	$31 - $220	112%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$32	115%
Employer Direct Healthcare	$43	155%
Fairprice Healthcare Holdings	$49	177%
Coventry	$61	220%
Cigna	$158	570%

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 $30.
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 Mary's General 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.