CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Southwest General Health Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $89
Cash Discount Price: $133
vs. Medicare Baseline: 3.21x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Southwest General Health Center is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 3.21x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$133

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $133 (480%)

Insurance Median: $89 (321%)

Cash: $133 (480% of Medicare)

Ins. Median: $89 (321% 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 321% of the Medicare baseline (a markup of 221%). 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
Medical Mutual	$15 - $17	54%
Medical Mutual-Ohio	$15	54%
Buckeye	$47 - $116	170%
Molina	$47 - $116	170%
Healthsmart	$53 - $63	191%
Health Design Plus	$61 - $73	220%
Humana	$64 - $116	231%
Clarity Health	$66 - $78	238%
Healthspan	$66 - $78	238%
Healthsmart Preferred	$74 - $88	267%
Ohio Health Choice Plus	$80 - $95	289%
Aetna	$89 - $106	321%
Summacare	$89 - $106	321%
UnitedHealthcare	$89 - $116	321%
Coventry	$114 - $135	411%
First Health	$114 - $135	411%
Amerihealth Caritas	$116	418%
Blue Cross Blue Shield	$116	418%
Caresource	$116	418%
Ohio Health Choice	$128 - $152	462%
Private Healthare Systems	$132 - $157	476%
Cigna	$184	664%

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 $133.
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 Southwest General Health Center 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.