Physical therapy (manual therapy)
Facility: Nmc Health
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $93
- Cash Discount Price: $92
- vs. Medicare Baseline: 3.35x 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 335% of the Medicare baseline (a markup of 235%). 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 |
|---|---|---|
| Bluestem Pace | $26 | 94% |
| Leading Age | $42 | 152% |
| Medicaid / KanCare | $42 | 152% |
| Aetna | $58 - $129 | 209% |
| Blue Cross Blue Shield | $58 | 209% |
| Wppa | $65 - $86 | 234% |
| Occunet | $71 - $94 | 256% |
| Medincrease Health Plan | $77 - $101 | 278% |
| Samaritan Ministries International | $77 - $101 | 278% |
| Prime Health Services | $89 - $117 | 321% |
| UnitedHealthcare | $106 - $140 | 382% |
| Cigna | $112 - $148 | 404% |
Consumer Guidance & Cost Commentary
For the CPT code 97140, representing physical therapy (manual therapy), the gross charge at Nmc Health in Newton, KS is $132.00. This facility is an acute care hospital owned by a voluntary non-profit private entity. While the cash median price for this service is $92.00, the negotiated rates vary significantly by payer, ranging from $26.00 for Bluestem Pace and Leading Age up to $148.00 for Cigna. It is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures; therefore, patients with high-deductible plans may find paying the cash price of $92.00 more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the negotiated rate exceeds the patient's deductible.
To ensure you receive the most favorable rate, it is recommended to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% for upfront payment. Additionally, since Medicare serves as the objective baseline for healthcare pricing, the facility's gross charge is 3.4 times the Medicare amount of $27.72. When reviewing your specific plan, verify whether your insurance allows you to pay the cash price directly, as this can sometimes bypass the higher negotiated rates charged to insured members. Always request an itemized bill before payment to ensure all charges are accurate and to identify any potential errors that could be corrected.