CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Mercy Hospital of Buffalo

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $29
Cash Discount Price: $72
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Mercy Hospital of Buffalo is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 1.05x the Medicare baseline. Located in 565 Abbott Road, Buffalo, NY.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$29

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: $72 (260%)

Insurance Median: $29 (105%)

Cash: $72 (260% of Medicare)

Ins. Median: $29 (105% 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
UnitedHealthcare	$16 - $31	58%
Medicaid / KanCare	$21 - $34	76%
Univera Healthcare Essential [100170]	$23	83%
Univera Healthcare [100169]	$23 - $30	83%
VA Veterans Affairs [700001]	$24 - $26	87%
Fidelis Essential [100163]	$24 - $31	87%
Beacon Essential [350122]	$24 - $32	87%
Cigna	$26 - $38	94%
Seneca Nation [450119]	$26	94%
Hospice [550001]	$26	94%
Covid19 Hrsa [45013]	$26	94%
Medicare (plans)	$26 - $67	94%
Fallon Health [450115]	$26	94%
Humana	$26	94%
Magnacare [100142]	$26	94%
Meritain [100063]	$26	94%
Blue Cross Blue Shield	$26 - $48	94%
Aetna	$26 - $28	94%
Champ VA [700002]	$26	94%
Tricare	$26	94%
Catholic Health Life Pace [400005]	$26	94%
Wellcare Fidelis Dual [450451]	$28	101%
UPMC Health Plan [100181]	$28 - $47	101%
Fidelis Dual Advantage [450120]	$28	101%
Ghi [100153]	$29	105%
Wellcare [450129]	$29	105%
Independent Health [100165]	$30 - $82	108%
Iha First Choice [800001]	$30 - $74	108%
Fidelis Exchange [100164]	$31	112%
Independent Health Essential [100166]	$31 - $41	112%
Beacon Health Options [100023]	$32	115%
Mvp Healthcare [100168]	$35	126%
Federal Workers Compensation [500100]	$36	130%
No Fault [114001]	$36	130%

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 $72.
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 Mercy Hospital of Buffalo 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.