Physical therapy (manual therapy)
Facility: Hiawatha Community Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $150
- Cash Discount Price: $193
- vs. Medicare Baseline: 5.41x 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 541% of the Medicare baseline (a markup of 441%). 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 | $55 - $58 | 198% |
| UnitedHealthcare | $71 - $166 | 256% |
| Aetna | $71 - $156 | 256% |
| Humana | $72 | 260% |
| Ambetter / Centene | $86 | 310% |
| Centrus Health Direct - All Plans | $145 | 523% |
| Oscar - All Plans | $145 | 523% |
| Preferred Hlth - All Plans | $174 | 628% |
| Cigna | $183 | 660% |
| Wppa Providrs Care - All Plans | $183 | 660% |
| Midlands Choice - All Plans | $187 | 675% |
| Multiplan - All Plans | $187 | 675% |
| Healthy Blue Mcaid - All Plans | $193 | 696% |
Consumer Guidance & Cost Commentary
For the physical therapy service (CPT 97140) at Hiawatha Community Hospital, the cash price is $193.00, which matches the facility's gross chargemaster rate. While the median negotiated rate across 13 payers is $150.00, the cash price remains the highest figure in this dataset. It is important to note that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price of $193.00 upfront can sometimes be more cost-effective than using insurance, as the insurer's allowed amount may exceed the cash rate. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can lower the final cost significantly compared to the standard cash price.
When evaluating this rate against broader benchmarks, the facility's cash price of $193.00 is notably higher than the state of Kansas average, which is $148.00. This difference highlights the importance of comparing rates to the state median rather than just the hospital's internal list price. Furthermore, the facility's cash price is 5.4 times the Medicare benchmark amount of $27.72, illustrating that commercial rates often include substantial markups over the federal cost baseline. To ensure you are not overcharged, we recommend requesting a full itemized bill to verify that no unbundled codes or services not rendered are included, and disputing any balance billing if you receive a surprise charge from an out-of-network provider at this in-network facility.