Physical therapy (manual therapy)
Facility: Susan B Allen Memorial Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $554
- Cash Discount Price: $80
- vs. Medicare Baseline: 19.99x 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 1999% of the Medicare baseline (a markup of 1899%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 1263% |
| Providrs Care | $757 | 2731% |
Consumer Guidance & Cost Commentary
For the CPT code 97140 (Physical therapy manual therapy) at Susan B Allen Memorial Hospital in El Dorado, KS, the cash median price is $80.00, which is significantly lower than the facility's negotiated rates of $554.00 and the commercial payer ranges of $350 to $757. While the facility's cash rate is notably lower than the state average, patients with high-deductible plans may find that paying cash upfront is the most cost-effective option, as the insurance negotiated rates often exceed the cash price. To secure the lowest possible amount, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass the administrative overhead and contractual markups associated with insurance billing.
It is important to understand that the $123.00 gross chargemaster rate listed is not the amount you will pay; commercial insurance contracts typically cap payments at negotiated rates, which are often higher than cash prices due to administrative costs and contract dynamics. If you choose to use insurance, be aware that balance billing is generally prohibited for out-of-network services at in-network facilities under the No Surprises Act, but you should still verify your specific plan's allowed amount to avoid unexpected costs. Furthermore, if you receive an itemized bill, you have the right to request a full line-by-line audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies that can be resolved to reduce your final debt.