Physical therapy (manual therapy)
Facility: Memorial Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $79
- Cash Discount Price: $127
- vs. Medicare Baseline: 2.85x 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 285% of the Medicare baseline (a markup of 185%). 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 | $53 | 191% |
| Medicare (plans) | $56 - $72 | 202% |
| Tricare | $56 - $72 | 202% |
| Humana | $56 - $72 | 202% |
| Ambetter / Centene | $61 - $79 | 220% |
| Coventry - All Other Plans | $100 - $129 | 361% |
| Health Partners Of Kansas - All Plans | $105 - $136 | 379% |
| Preferred Healthcare-All Plans | $105 - $136 | 379% |
| Wppa/Providers Care-All Plans | $155 - $200 | 559% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Memorial Hospital in Abilene, KS, the cash price is $127.00, which matches the facility's median cash rate. While insurance plans like Blue Cross Blue Shield and Medicare have negotiated rates ranging from $53 to $129, paying out-of-pocket directly can sometimes be more cost-effective for patients with high deductibles, as the cash price often aligns closely with or exceeds the insurer's allowed amount. It is important to note that commercial negotiated rates frequently include administrative overhead and do not represent the true cost of care; comparing these rates to the Medicare benchmark of $27.72 reveals a significant markup, suggesting that the commercial pricing structure is substantially higher than the federal baseline for this service.
Patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, though unexpected charges can still occur if ancillary services are out-of-network. To avoid surprise costs, consumers should request a full itemized bill before paying, as summary invoices may hide unbundled charges or services not rendered. Additionally, many facilities offer prompt-pay discounts for upfront payment, which can reduce the total owed by 20% to 50%, so it is advisable to ask the hospital directly about self-pay or cash discount options prior to scheduling your appointment.