CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Lodi Community Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $120
Cash Discount Price: $145
vs. Medicare Baseline: 4.33x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Lodi Community Hospital is $120. 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 4.33x the Medicare baseline. Located in 225 Elyria Street, Lodi, OH.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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: $120 (433%)

Cash: $145 (523% of Medicare)

Ins. Median: $120 (433% 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 433% of the Medicare baseline (a markup of 333%). 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	$35 - $182	126%
UnitedHealthcare	$35 - $138	126%
Humana	$67	242%
Mmo	$67 - $119	242%
Oscar	$67 - $86	242%
Summacare	$67 - $137	242%
United	$67 - $159	242%
Aetna	$76 - $223	274%
The Health Plan	$89 - $178	321%
Amish Community Aid Plan	$100 - $112	361%
Buckeye	$105	379%
Caresource	$105	379%
Ohcp	$108	390%
Molina	$110	397%
Aultcare	$112	404%
Omas	$112	404%
Amerihealth	$115	415%
Ohio Healthy	$120	433%
Php	$134	483%
Phphi	$134	483%
Upmc	$134	483%
Cigna	$144	519%
Cc Ehp	$150	541%
Gms	$156	563%
Medical Benefit Corp	$156	563%
Consociate Health	$167	602%
Frontpath	$201	725%
Managed Care Services	$201	725%
Multiplan	$201	725%
Tertiary Care Network	$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 Lodi Community 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.