CMS Price Transparency Data
Physical therapy (manual therapy)
Facility: St Charles Madras
Billing Code: 97140 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97140
- Insurance Median: $56
- Cash Discount Price: $113
- vs. Medicare Baseline: 2.02x Medicare
The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at St Charles Madras is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 2.02x the Medicare baseline. Located in 470 Ne A Street, Madras, OR.
Cash / Self-Pay
$113
Average discount available for prompt cash payment at this facility.
Insurance Median
$56
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: $113 (408%)
Insurance Median: $56 (202%)
Cash: $113 (408% of Medicare)
Ins. Median: $56 (202% 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 202% of the Medicare baseline (a markup of 102%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 |
|---|---|---|
| Pacificsource Community Solutions [525] | $23 - $25 | 83% |
| Aetna | $33 - $139 | 119% |
| Ageright Advantage [142] | $33 - $38 | 119% |
| Champ Va [700] | $33 - $38 | 119% |
| Cigna | $33 - $101 | 119% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $33 - $38 | 119% |
| Devoted Health Inc [145] | $33 - $38 | 119% |
| Health Market Care Assured [134] | $33 - $38 | 119% |
| Health Net Med Adv [135] | $33 - $38 | 119% |
| Humana | $33 - $38 | 119% |
| Indian Health [704] | $33 - $38 | 119% |
| Kaiser Permanente Med Adv [136] | $33 - $38 | 119% |
| Law Enforcement [701] | $33 - $79 | 119% |
| Medicare (plans) | $33 - $45 | 119% |
| Otj Dept Of Labor Federal Emp [652] | $33 | 119% |
| Otj Us Department Of Labor [669] | $33 | 119% |
| Samaritan Health Plan Med Adv [141] | $33 - $38 | 119% |
| Unicare [133] | $33 - $38 | 119% |
| UnitedHealthcare | $33 - $148 | 119% |
| Veterans [706] | $33 - $38 | 119% |
| Wellcare [132] | $33 - $38 | 119% |
| Blue Cross Blue Shield | $36 - $98 | 130% |
| Tricare | $43 - $50 | 155% |
| Kaiser Permanente [334] | $51 - $139 | 184% |
| Auto Allstate Insurance [602] | $55 | 198% |
| Auto American Family Insurance [603] | $55 | 198% |
| Auto Country Insurance Claims [604] | $55 | 198% |
| Auto Dairyland Insurance [617] | $55 | 198% |
| Auto Farmers [605] | $55 | 198% |
| Auto Geico Claims Oregon [606] | $55 | 198% |
| Auto Hartford [612] | $55 | 198% |
| Auto Liberty Mutual Auto Ins [613] | $55 | 198% |
| Auto Mutual Of Enumclaw [610] | $55 | 198% |
| Auto Nationwide Allied Insuranc [601] | $55 | 198% |
| Auto Oregon Mutual [614] | $55 | 198% |
| Auto Progressive [608] | $55 | 198% |
| Auto Safeco Concentra [600] | $55 | 198% |
| Auto State Farm Claims [609] | $55 | 198% |
| Auto Sublimity Insurance [616] | $55 | 198% |
| Auto Travelers Insurance [615] | $55 | 198% |
| Auto Usaa [611] | $55 | 198% |
| Generic Auto [649] | $55 | 198% |
| Generic Workers Comp [699] | $55 | 198% |
| Moda [310] | $55 - $121 | 198% |
| Otj Broadspire Services [670] | $55 | 198% |
| Otj Ccmsi [618] | $55 | 198% |
| Otj Chartis Claims [650] | $55 | 198% |
| Otj City County Ins Services [662] | $55 | 198% |
| Otj Corvel [676] | $55 | 198% |
| Otj Esis West Wc Claims [653] | $55 | 198% |
| Otj Gallagher Bassett [654] | $55 | 198% |
| Otj Hartford [655] | $55 | 198% |
| Otj Intermountain Claims Inc [666] | $55 | 198% |
| Otj Liberty Mutual Wausau Underwriters [671] | $55 | 198% |
| Otj Penser No American [663] | $55 | 198% |
| Otj Pinnacle Risk Mgmt [661] | $55 | 198% |
| Otj Saif [667] | $55 | 198% |
| Otj Sedgwick Cms [660] | $55 | 198% |
| Otj Sedgwick [668] | $55 | 198% |
| Otj Travelers Insurance [672] | $55 | 198% |
| Otj Tristar [673] | $55 | 198% |
| Pacificsource [345] | $55 - $88 | 198% |
| Providence Health Plan [347] | $55 - $140 | 198% |
| Advanced Health [534] | $56 - $66 | 202% |
| Allcare Health Plan [538] | $56 - $66 | 202% |
| Cascade Health Alliance [532] | $56 - $66 | 202% |
| Columbia Pacific Coordinated Care Llc [539] | $56 - $66 | 202% |
| Health Share Care Oregon [526] | $56 - $66 | 202% |
| Health Share Kaiser [543] | $56 - $66 | 202% |
| Health Share Ohsu Ohp [552] | $56 - $66 | 202% |
| Health Share Providence [548] | $56 - $66 | 202% |
| Health Share [537] | $56 - $66 | 202% |
| Intercommunity Health [530] | $56 - $66 | 202% |
| Jackson Care Connect [542] | $56 - $66 | 202% |
| Medicaid / KanCare | $56 - $66 | 202% |
| Primary Health Of Jospehine County Llc [547] | $56 - $66 | 202% |
| Umpqua Health [533] | $56 - $66 | 202% |
| Willamette Valley Community Health [536] | $56 - $66 | 202% |
| Yamhill County Coordinated Care Org [550] | $56 - $66 | 202% |
| Bridgespan [342] | $84 | 303% |
| Us Benefits [326] | $87 - $101 | 314% |
| Asuris Northwest Health [202] | $98 | 354% |
| Healthcare Management Admin [201] | $98 | 354% |
| Regence Group Administrators [203] | $98 | 354% |
| Rocky Mountain Administrators [405] | $110 - $128 | 397% |
| Rx Internal [4100003] | $112 - $131 | 404% |
| First Choice Health [317] | $119 - $139 | 429% |
| Samaritan [376] | $119 - $139 | 429% |
| Meritain Health [300] | $120 - $139 | 433% |
| Health Net [340] | $129 - $150 | 465% |
| Administrative Concepts Inc [402] | $135 - $157 | 487% |
| First Health [339] | $135 - $157 | 487% |
| Manhattan Life Insurance Company [379] | $135 - $157 | 487% |
| Philadelphia American Life Insurance Company [395] | $135 - $157 | 487% |
| Planned Administrators Inc [375] | $135 - $157 | 487% |