Physical therapy (manual therapy)
Facility: Hamilton County Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $90
- Cash Discount Price: $100
- vs. Medicare Baseline: 3.25x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 325% of the Medicare baseline (a markup of 225%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $24 - $58 | 87% |
| First Health Coventry - All Plans | $85 | 307% |
| Cigna | $95 | 343% |
| UnitedHealthcare | $95 | 343% |
| Va Ccn - All Plans | $100 | 361% |
| Aetna | $170 | 613% |
Consumer Guidance & Cost Commentary
For the CPT code 97140, representing physical therapy with manual therapy, Hamilton County Hospital in Syracuse, KS, lists a cash price of $100.00. This cash rate is significantly lower than the state average for this service, which is $27.72 according to Medicare benchmarks, though it is important to note that Medicare rates often reflect the true cost of delivery rather than commercial markups. While the facility's cash price exceeds the Medicare amount, patients with high-deductible plans may find paying cash directly more affordable than using insurance, as commercial negotiated rates for this service range from $24 to $170 depending on the payer. To maximize savings, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid in full upfront, bypassing the administrative costs and delayed reimbursement cycles associated with insurance claims.
Commercial insurance negotiations for this procedure vary widely across payers, with allowed amounts ranging from $24 for Blue Cross Blue Shield to $170 for Aetna. These negotiated rates often exceed the cash price due to the administrative overhead and contract structures inherent in insurance billing. Patients should be aware that assuming an in-network rate is the lowest possible price is a common pitfall, as different insurers have distinct contract ceilings. Furthermore, if a patient receives care from an out-of-network provider or encounters services billed separately, they could face balance billing for the difference between the provider's full charge and the insurance allowed amount, a practice restricted for emergency care under federal law. To avoid unexpected costs, consumers should request a detailed, itemized bill to review specific