CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Wellspan Ephrata Community Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $142
Cash Discount Price: $206
vs. Medicare Baseline: 5.12x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Wellspan Ephrata Community Hospital is $142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $206. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 5.12x the Medicare baseline. Located in 169 Martin Avenue, Ephrata, PA.

Cash / Self-Pay

$206

Average discount available for prompt cash payment at this facility.

Insurance Median

$142

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: $206 (743%)

Insurance Median: $142 (512%)

Cash: $206 (743% of Medicare)

Ins. Median: $142 (512% 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 512% of the Medicare baseline (a markup of 412%). 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	$26 - $229	94%
Medicare (plans)	$26 - $52	94%
Highmark	$41 - $120	148%
Medicaid / KanCare	$46 - $89	166%
Blue_Cross	$99 - $191	357%
Cigna	$134 - $189	483%
Wellspan_Capital_Blue_Cross	$141 - $189	509%
Geisinger	$143 - $192	516%
Independence_Blue_Cross	$143 - $192	516%
Tower Health	$143 - $203	516%
Upmc	$143 - $237	516%
Phc	$154 - $210	556%
First_Health_Network	$187	675%
United_Healthcare	$207 - $279	747%

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 $206.
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 Wellspan Ephrata 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.