CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Adena Pike Medical Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $154
Cash Discount Price: $102
vs. Medicare Baseline: 5.56x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Adena Pike Medical Center is $154. 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 5.56x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$102

Average discount available for prompt cash payment at this facility.

Insurance Median

$154

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: $154 (556%)

Cash: $102 (368% of Medicare)

Ins. Median: $154 (556% 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 556% of the Medicare baseline (a markup of 456%). 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
Aetna	$49 - $166	177%
Blue Cross Blue Shield	$49 - $176	177%
Buckeye Community Health Plan	$49	177%
Humana	$49 - $194	177%
Medical Mutual Of Ohio	$49 - $130	177%
Medigold	$49	177%
Molina	$49	177%
Care Source	$50	180%
Gateway Health	$67	242%
Molina Marketplace	$80	289%
Care Source Just4Me	$88	317%
Sidecar Health	$135	487%
Ohio Ppo Connect	$143	516%
The Health Plan	$143	516%
Cigna	$148	534%
Medical Mutual Of Ohio Supermed	$154	556%
First Health	$160	577%
Ohio Health Choice	$163	588%
UnitedHealthcare	$176	635%
Integrated Health Plan	$192	693%
Healthsmart	$194	700%
Multiplan/Private Healthcare Systems	$194	700%
Three Rivers Network	$194	700%

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 Pike 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.