CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: South Pointe Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $102
Cash Discount Price: $145
vs. Medicare Baseline: 3.68x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at South Pointe Hospital is $102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $145. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 3.68x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$102

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: $145 (523%)

Insurance Median: $102 (368%)

Cash: $145 (523% of Medicare)

Ins. Median: $102 (368% 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 368% of the Medicare baseline (a markup of 268%). 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
United	$34 - $238	123%
Aetna	$35 - $223	126%
Humana	$35 - $190	126%
Summacare	$35 - $83	126%
The Health Plan	$35 - $134	126%
UnitedHealthcare	$35 - $138	126%
Upmc	$35 - $134	126%
Valor	$35	126%
Cigna	$36 - $178	130%
Perennial Health	$38	137%
Oscar	$67 - $86	242%
Paramount	$83	299%
Blue Cross Blue Shield	$85 - $144	307%
Buckeye	$85	307%
Molina	$85	307%
Caresource	$86	310%
Amerihealth	$89	321%
Cc Ehp	$89 - $90	321%
Aultcare	$96	346%
Ohcp	$108	390%
Omas	$112	404%
Mmo	$120 - $134	433%
Ohio Healthy	$120	433%
Healthsmart	$123	444%
Php	$134	483%
Gms	$156	563%
Medical Benefit Corp	$156	563%
Quality Care Partners	$156	563%
Consociate Health	$167	602%
Frontpath	$201	725%
Managed Care Services	$201	725%
Multiplan	$201	725%
Tertiary Care Network	$201	725%
Three Rivers	$201	725%

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 $145.
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 South Pointe 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.