CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Sanford Vermillion Medical Center

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $113
Cash Discount Price: $128
vs. Medicare Baseline: 4.08x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Sanford Vermillion Medical Center is $113. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 4.08x the Medicare baseline. Located in 20 South Plum Street, Vermillion, SD.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$113

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$27.72

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $27.72 (100%)

Cash / Self-Pay: $128 (462%)

Insurance Median: $113 (408%)

Cash: $128 (462% of Medicare)

Ins. Median: $113 (408% of 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 408% of the Medicare baseline (a markup of 308%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Sanford Health Plan Align	$47	170%
Wellmark Sd	$49	177%
Ucare	$52 - $141	188%
Aetna	$53 - $139	191%
Health Partners	$53 - $120	191%
Medicare (plans)	$53	191%
UnitedHealthcare	$53 - $134	191%
Primewest	$54	195%
Sanford Health Plan	$63 - $85	227%
Security Health Plan	$88	317%
Medica	$132 - $141	476%
Wellmark	$138 - $139	498%
First Choice Health Network	$144	519%
Healthez	$144	519%
Multiplan	$144	519%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $128.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97140.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sanford Vermillion Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97140.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.