Physical therapy (manual therapy)
Facility: Fredonia Regional Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $61
- Cash Discount Price: $74
- vs. Medicare Baseline: 2.20x 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 220% of the Medicare baseline (a markup of 120%). 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 | $33 - $58 | 119% |
| Veterans Programs - All Plans | $34 - $41 | 123% |
| UnitedHealthcare | $34 - $229 | 123% |
| Aetna | $34 - $73 | 123% |
| Meritain-All Plans | $61 - $73 | 220% |
| Reserve National-All Plans | $61 - $73 | 220% |
| Cigna | $61 - $73 | 220% |
Consumer Guidance & Cost Commentary
For Physical therapy (manual therapy) at Fredonia Regional Hospital in Fredonia, KS, the cash price is $74.00, which matches the facility's median negotiated rate of $61.00 and the cash median. This service is billed under CPT code 97140. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that insurance negotiated rates can sometimes exceed cash prices. For instance, UnitedHealthcare has a high-end negotiated rate of $229, which is significantly higher than the cash price; in such cases, paying out-of-pocket might result in lower total costs for patients with high-deductible plans. It is always advisable to confirm "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling to ensure you are receiving the most favorable rate available.
When reviewing your bill, remember that commercial insurance rates often include administrative overhead, which can inflate the baseline price by 20% to 40% compared to direct cash payments. Although the Medicare amount for this code is $27.72, commercial payers like Blue Cross Blue Shield and Veterans Programs have negotiated rates ranging from $33 to $58, which are higher than the Medicare benchmark but lower than the facility's gross charge of $74.00. If you receive a bill that appears to include balance billing for out-of-network services, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Always request a full itemized CPT-coded bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as