CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Adena Fayette Medical Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $136
Cash Discount Price: $102
vs. Medicare Baseline: 4.91x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Adena Fayette Medical Center is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $102. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 4.91x the Medicare baseline. Located in 1430 Columbus Avenue, Washington Ch, OH.

Cash / Self-Pay

$102

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $102 (368%)

Insurance Median: $136 (491%)

Cash: $102 (368% of Medicare)

Ins. Median: $136 (491% 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 491% of the Medicare baseline (a markup of 391%). 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	$70 - $136	253%
Aetna	$84 - $162	303%
Buckeye Community Health Plan	$84	303%
Humana	$84	303%
Medical Mutual Of Ohio	$84 - $154	303%
Medigold	$84	303%
Molina	$84	303%
Care Source	$85	307%
Molina Marketplace	$92	332%
United Medical Resources Ohcp	$129	465%
UnitedHealthcare	$129 - $130	465%
Cigna	$141	509%
Ohio Ppo Connect	$143	516%
The Health Plan	$143	516%
Care Source Just4Me	$151	545%
Medical Mutual Of Ohio Supermed	$154	556%
First Health	$160	577%
Ohio Health Choice	$163	588%
Multiplan/Private Healthcare Systems	$194	700%
Sidecar Health	$231	833%

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 $102.
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 Adena Fayette Medical 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.