CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Clarion Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $48
Cash Discount Price: $78
vs. Medicare Baseline: 1.73x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Clarion Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 1.73x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $78 (281%)

Insurance Median: $48 (173%)

Cash: $78 (281% of Medicare)

Ins. Median: $48 (173% 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.

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
Upmc	$15 - $106	54%
Highmark	$23 - $72	83%
Highmark - Ind.& Managed Care	$23 - $72	83%
Martin'S Point - Usfhp	$24 - $74	87%
Gateway	$25 - $78	90%
Amerihealth	$26	94%
Cigna	$26 - $106	94%
Highmark Community Blue	$26	94%
Medicare (plans)	$26	94%
Tricare	$26	94%
UnitedHealthcare	$26	94%
Aetna	$27 - $188	97%
Devoted Health Plan	$27 - $84	97%
Geisinger	$28	101%
Pa Health & Wellness	$28	101%
The Health Plan	$28 - $62	101%
American Health Plan	$29	105%
Peak Health	$48 - $148	173%
Workers Comp	$49 - $78	177%
Devon	$51 - $158	184%

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 $78.
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 Clarion 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.