Physical therapy (manual therapy)
Facility: Ashland Health Center
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $83
- Cash Discount Price: $66
- vs. Medicare Baseline: 2.99x 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 299% of the Medicare baseline (a markup of 199%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $28 | 101% |
| Compalliance-All Plans | $66 | 238% |
| Health Partners Of Kansas-All Plans | $71 | 256% |
| Multiplan-All Plans | $81 | 292% |
| Medica Mcare - All Plans | $83 | 299% |
| Medicare (plans) | $83 | 299% |
| UnitedHealthcare | $83 | 299% |
| Medicaid / KanCare | $83 | 299% |
| Aetna | $83 | 299% |
| Healthy Blue Mcr Adv - All Other Plans | $83 | 299% |
| Health Choice-All Plans | $83 | 299% |
| Providers Care (Wppa)-All Plans | $124 | 447% |
Consumer Guidance & Cost Commentary
For the CPT code 97140, representing physical therapy with manual therapy, the negotiated rates at Ashland Health Center in Ashland, KS, are consistently $83.00 across all major payers, including Medicare, Medicaid, and commercial insurers like UnitedHealthcare and Aetna. This negotiated amount matches the facility's cash median of $66.00, meaning patients paying out-of-pocket would not save money compared to using insurance, as the insurance negotiated rate is identical to the facility's standard billing. However, for patients with high-deductible plans who have not yet met their out-of-pocket maximum, the $83.00 allowed amount may be more affordable than the $66.00 cash price if the patient's insurance deductible has not been satisfied, as they would still owe the difference between the allowed amount and their deductible.
The facility, a Critical Access Hospital in Kansas, reports a vs_medicare value of 3.0, indicating that the commercial negotiated rates are slightly higher than the federal Medicare benchmark of $27.72 for this service. While the data does not provide specific county or state average comparisons for this code, the consistent $83.00 rate across 12 different payer plans suggests a standardized pricing structure typical of in-network agreements. Patients should be aware that while balance billing is generally prohibited for in-network services under the No Surprises Act, it is crucial to verify network status before scheduling to avoid unexpected costs. Additionally, patients should explicitly ask the billing department about "prompt-pay" discounts or self-pay rates before check-in, as these upfront payment incentives can sometimes reduce the final balance, though in this specific case, the