CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Astria Toppenish Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $178
Cash Discount Price: $183
vs. Medicare Baseline: 6.42x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Astria Toppenish Hospital is $178. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $183. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 6.42x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$183

Average discount available for prompt cash payment at this facility.

Insurance Median

$178

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: $183 (660%)

Insurance Median: $178 (642%)

Cash: $183 (660% of Medicare)

Ins. Median: $178 (642% 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 642% of the Medicare baseline (a markup of 542%). 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
Ambetter / Centene	$16	58%
Medicaid / KanCare	$16 - $48	58%
Medicare (plans)	$16 - $235	58%
Molina	$16	58%
UnitedHealthcare	$16 - $235	58%
Va	$16	58%
Molina_Exchange	$21	76%
Aetna	$27 - $250	97%
Cigna	$27	97%
Humana	$27 - $284	97%
Li	$27	97%
Tricare	$27	97%
Zenith	$28	101%
Regence	$91 - $96	328%
Premera	$101 - $107	364%
Premera_Affordable_Care	$101 - $107	364%
Kaiser	$107	386%
Chpw_Cascade_Care	$169 - $179	610%
First_Choice	$186 - $196	671%
Tpsc	$210 - $222	758%
Bcchp	$269 - $284	970%
Great_Rivers	$269 - $284	970%
Healthcomp	$269 - $284	970%
Washington_State_Hca	$269 - $284	970%

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 $183.
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 Astria Toppenish 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.