CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Hamilton Memorial Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $87
Cash Discount Price: $92
vs. Medicare Baseline: 3.14x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Hamilton Memorial Hospital is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $92. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 3.14x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$92

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $92 (332%)

Insurance Median: $87 (314%)

Cash: $92 (332% of Medicare)

Ins. Median: $87 (314% 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 314% of the Medicare baseline (a markup of 214%). 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	$27 - $104	97%
Blue Cross Blue Shield	$27 - $105	97%
Health Alliance	$27 - $92	97%
Medicare (plans)	$27 - $46	97%
UnitedHealthcare	$27 - $83	97%
Wellcare	$27 - $46	97%
Medicaid / KanCare	$38 - $46	137%
Humana	$41 - $46	148%
Alliance Coal	$71 - $81	256%
Healthscope	$71 - $81	256%
Wellfirst (Ssmhic)	$71 - $81	256%
Hope Trust	$76 - $87	274%
Cigna	$80 - $91	289%
Hfn, Inc	$81 - $104	292%
Healthlink	$87 - $104	314%
Multiplan	$87 - $98	314%
Siho	$92 - $104	332%
Three Rivers Provider	$92 - $104	332%
Healthsmart	$97 - $110	350%
Stratose	$97 - $110	350%

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 $92.
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 Hamilton Memorial 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.