Physical therapy (manual therapy)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $74
- Cash Discount Price: $77
- vs. Medicare Baseline: 2.67x 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 267% of the Medicare baseline (a markup of 167%). 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 |
|---|---|---|
| Humana | $43 - $47 | 155% |
| Tricare | $46 - $50 | 166% |
| Va Ccn - All Plans | $54 - $59 | 195% |
| Aetna | $54 - $86 | 195% |
| Medicaid / KanCare | $54 - $95 | 195% |
| UnitedHealthcare | $54 - $95 | 195% |
| Ambetter / Centene | $59 - $65 | 213% |
| Blue Cross Blue Shield | $79 | 285% |
| Health Partners - All Plans | $83 - $90 | 299% |
| Healthy Blue Mcaid - All Plans | $87 - $95 | 314% |
Consumer Guidance & Cost Commentary
For the CPT code 97140, representing physical therapy with manual therapy, Trego County Lemke Memorial Hospital lists a cash median price of $77.00, which is lower than the facility's negotiated rates paid by major payers like UnitedHealthcare ($54–$95) and Medicaid/KanCare ($54–$95). While the facility's gross charge is $91.00, patients with high-deductible plans may find paying cash directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price. It is important to note that this facility is a Critical Access Hospital in Wakeeney, KS, and while specific county or state average data was not provided in the current dataset, patients should always verify if their specific insurance plan's negotiated rate is higher than the cash option before scheduling.
The Medicare benchmark for this service is $27.72, which serves as a baseline to evaluate the facility's pricing markup; the cash rate of $77.00 represents a significant increase over this federal standard. Patients should be aware that hospitals often offer prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, effectively bypassing the administrative costs associated with insurance claims processing. To secure these discounts, patients must request self-pay classification and prompt-pay rates prior to check-in and may need to sign a waiver to prevent automatic claims submission. Additionally, since this is a government-owned facility, patients should confirm whether any balance billing protections apply to their specific situation, though the No Surprises Act generally protects against unexpected out-of-network charges at in-network facilities.