Physical therapy (manual therapy)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $64
- Cash Discount Price: $67
- vs. Medicare Baseline: 2.31x 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 231% of the Medicare baseline (a markup of 131%). 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 |
|---|---|---|
| Tricare | $54 | 195% |
| Humana | $61 | 220% |
| Aetna | $62 - $67 | 224% |
| Hpk-All Plans | $64 | 231% |
| UnitedHealthcare | $64 | 231% |
| Medicaid / KanCare | $67 | 242% |
Consumer Guidance & Cost Commentary
For the CPT code 97140, representing physical therapy (manual therapy), the negotiated rates for this service at Medicine Lodge Memorial Hospital range from $54 to $67, with a median negotiated payment of $64.00. This facility is a Critical Access Hospital in Medicine Lodge, Kansas, and its pricing structure is notably higher than the state average, which is $27.72. While the cash price is listed at $67.00, patients with high-deductible plans may find that paying cash directly is more cost-effective than using insurance, as the insurer's negotiated rate of $64.00 often exceeds the cash price. It is important to note that commercial rates can sometimes be inflated by administrative overhead, and patients should verify their specific plan's deductible status before scheduling to avoid unexpected out-of-pocket costs.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is crucial to request a full itemized bill before paying any invoice. Hospitals often issue summary bills that obscure individual charges, so consumers should demand a line-by-line statement to identify any unbundled codes or services not rendered. Additionally, asking about "self-pay" or "prompt-pay" discounts prior to check-in can significantly reduce the final amount owed, as these upfront payment incentives bypass the costly claims processing cycle and administrative fees associated with insurance billing.