Physical therapy (manual therapy)
Facility: Lane County Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $90
- Cash Discount Price: $90
- vs. Medicare Baseline: 3.25x 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 325% of the Medicare baseline (a markup of 225%). 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 |
|---|---|---|
| Aetna | $81 - $86 | 292% |
| UnitedHealthcare | $81 - $90 | 292% |
| Healthy Blue Mcr Adv - All Other Plans | $90 | 325% |
| Healthy Blue Mcaid | $90 | 325% |
| Medicaid / KanCare | $90 - $99 | 325% |
| Wppa Providers-All Plans | $135 | 487% |
Consumer Guidance & Cost Commentary
For the CPT code 97140, representing physical therapy (manual therapy) at Lane County Hospital in Dighton, Kansas, the cash and negotiated rates are both $90.00, which matches the facility's median paid amount. This rate is significantly higher than the Medicare benchmark of $27.72, reflecting a markup of 3.2 times the federal baseline. While commercial payers like Aetna and UnitedHealthcare have negotiated rates ranging from $81 to $90, these amounts remain well above the Medicare rate. For patients with high-deductible plans, paying the full cash price of $90.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overheads included in the insurance contract.
Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network services at in-network facilities, it is crucial to verify network status before scheduling. If you receive a bill that exceeds the negotiated rate, you may be facing balance billing for out-of-network ancillary services or errors in the claim. To resolve this, request a formal itemized billing audit to identify unbundled codes or services not rendered, as over 80% of hospital bills contain errors. Additionally, ask the hospital directly about self-pay or prompt-pay discounts, which can reduce the final cost by 20% to 50% if settled in full within 30 days, bypassing the costly insurance claims process.