Physical therapy (manual therapy)
Facility: Smith County Memorial Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $76
- Cash Discount Price: $81
- vs. Medicare Baseline: 2.74x 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 274% of the Medicare baseline (a markup of 174%). 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 | $50 | 180% |
| Medicaid / KanCare | $57 - $81 | 206% |
| Multiplan-All Plans | $73 | 263% |
| Wppa-All Plans | $76 | 274% |
| Health Partners Of Ks Ppo-All Plans | $77 | 278% |
| Midlands Choice-All Plans | $77 | 278% |
| UnitedHealthcare | $77 | 278% |
Consumer Guidance & Cost Commentary
For CPT code 97140, representing physical therapy with manual therapy at Smith County Memorial Hospital in Smith Center, KS, the cash median price is $81.00, which matches the facility's gross charge. This rate is significantly higher than the Medicare benchmark of $27.72, reflecting a markup of 2.7 times the federal baseline. While the facility is a Critical Access Hospital owned by the local government, patients should note that commercial negotiated rates for this service range from $50 to $81 depending on the insurance plan. For individuals with high-deductible plans, paying the cash price of $81.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates for many payers exceed the cash amount.
Before scheduling, it is crucial to verify your specific insurance plan's negotiated rate, as these vary widely across the seven payers listed, with Medicaid/KanCare plans showing a range of $57 to $81. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full before or shortly after the service. Additionally, since over 80% of hospital bills contain errors, you should request a detailed, itemized statement rather than accepting a summary bill, ensuring no charges are double-billed or for services not rendered. Always confirm your deductible status and whether the claim will be submitted to insurance, as automatic submission can void any cash discount agreements.