CMS Price Transparency Data

Physical therapy (manual therapy)

Facility: Saint Thomas Highlands Hospital

Billing Code: 97140 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97140
Insurance Median: $26
Cash Discount Price: $53
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Physical therapy (manual therapy) at Saint Thomas Highlands Hospital is $26. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $27.72, this hospital’s rate is 0.94x the Medicare baseline. Located in 401 Sewell Dr, Sparta, TN.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$26

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: $53 (191%)

Insurance Median: $26 (94%)

Cash: $53 (191% of Medicare)

Ins. Median: $26 (94% 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.

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
Blue Cross Blue Shield	$20 - $65	72%
Point Comfort Underwriters	$23	83%
Community Plan	$24	87%
Aetna	$26	94%
Amerigroup Mcr Replacement	$26	94%
Ascension Complete	$26	94%
Centurion Of Tn	$26	94%
Covid Uninsured Test Fund	$26	94%
Healthspring Mcr Replacement	$26	94%
Humana	$26	94%
Medicare (plans)	$26	94%
Nhc Advantage	$26	94%
UnitedHealthcare	$26	94%
Ambetter / Centene	$33	119%
Cigna	$35 - $40	126%
Oscar Health	$36	130%
Smart Health	$36	130%

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 $53.
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 Saint Thomas Highlands Hospital 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.