Physical therapy (manual therapy)
Facility: Rooks County Health Center
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $94
- Cash Discount Price: $78
- vs. Medicare Baseline: 3.39x 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 339% of the Medicare baseline (a markup of 239%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $49 | 177% |
| Celtic Mcr Adv | $49 | 177% |
| Tricare | $49 | 177% |
| Celtic Comm - All Other Plans | $54 | 195% |
| Blue Cross Blue Shield | $58 | 209% |
| Aetna | $94 | 339% |
| UnitedHealthcare | $94 | 339% |
| Preferred Benefits Admin | $94 | 339% |
| Preferred Hlthcare - All Other Plans | $99 | 357% |
| Health Partners - All Plans | $99 | 357% |
| Healthy Blue Mcaid - All Plans | $104 | 375% |
Consumer Guidance & Cost Commentary
For CPT code 97140, representing physical therapy with manual therapy, the facility's cash median rate is $78.00, which is lower than the negotiated rates paid by most insurance carriers. While the facility's cash price is significantly below the gross charge of $105.00, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance negotiated rate exceeds this amount. It is important to note that the facility's cash rate is notably higher than the state of Kansas average, suggesting that while self-pay options exist, they may not reflect the lowest possible cost in the region. Patients should always inquire directly with the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final bill.
The data indicates that the facility's negotiated rates average $94.00, which aligns with the median paid amount across all payers, though this is still higher than the cash price. When comparing to the Medicare benchmark of $27.72, the commercial negotiated rates represent a significant markup, a common practice where administrative costs and contract dynamics inflate the baseline price. Because the facility is a Critical Access Hospital in Plainville, KS, and operates under a government ownership structure, patients should be aware that balance billing protections may apply if they receive out-of-network care at this in-network facility. To avoid unexpected costs, consumers should request a full itemized bill to verify that all services rendered are accurately coded and that no unbundled charges or services not delivered have been included.