CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: UPMC Kane

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $81
Cash Discount Price: $104
vs. Medicare Baseline: 2.92x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at UPMC Kane is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $104. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 2.92x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$104

Average discount available for prompt cash payment at this facility.

Insurance Median

$81

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: $104 (375%)

Insurance Median: $81 (292%)

Cash: $104 (375% of Medicare)

Ins. Median: $81 (292% 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 292% of the Medicare baseline (a markup of 192%). 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
UPMC Health Plan	$23 - $168	83%
Aetna	$23 - $77	83%
UnitedHealthcare	$24 - $98	87%
Geisinger	$29	105%
Highmark Wholecare (Prev Gateway)	$31 - $76	112%
Amerihealth Caritas	$33 - $80	119%
PA Health & Wellness	$36	130%
UPMC Work Partners	$47	170%
Focus Healthcare	$52 - $190	188%
Blue Cross Blue Shield	$54 - $141	195%
Horizon Health Plan	$102 - $140	368%
Cigna	$102 - $4,502	368%
Multiplan	$109 - $150	393%
Health Coalition Partners	$116 - $160	418%
Intergroup	$116 - $160	418%

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 $104.
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 UPMC Kane 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.