Physical therapy (manual therapy)
Facility: Lmh
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $27
- Cash Discount Price: $60
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $23 - $155 | 83% |
| UnitedHealthcare | $23 - $185 | 83% |
| Aetna | $24 - $199 | 87% |
| Allwell | $24 - $27 | 87% |
| Medicare (plans) | $26 | 94% |
| Haskell Indian Health Services | $26 | 94% |
| Humana | $26 | 94% |
| Cigna | $26 - $160 | 94% |
| Ambetter / Centene | $35 - $41 | 126% |
| Non Contracted | $191 | 689% |
| First Health | $222 | 801% |
Consumer Guidance & Cost Commentary
For this physical therapy service at Lmh in Lawrence, KS, the cash price of $239 is significantly higher than the facility's own cash median of $60.00, suggesting the listed rate may include bundled fees or ancillary services. While the facility is government-owned and located in a rural area, the negotiated rates for major payers like Blue Cross Blue Shield and UnitedHealthcare range from $23 to $185, which are generally lower than the gross charge but still vary widely by plan. It is important to note that for patients with high-deductible plans, paying the cash price directly might be more cost-effective than using insurance if the insurer's negotiated rate exceeds the actual cash price, though this depends on individual plan deductibles and out-of-pocket maximums.
Patients should be aware that the facility's negotiated rates are subject to balance billing if care is received from out-of-network providers, although the No Surprises Act protects against surprise bills for emergency services at in-network facilities. To avoid unexpected costs, consumers should request a full itemized bill before paying, as summary bills often hide unbundled charges or services not rendered. Additionally, since the facility offers prompt-pay discounts for upfront payment, patients should inquire about self-pay or cash discounts prior to scheduling to potentially reduce the final amount owed, especially given that the facility's ownership status and location may influence specific contract terms.