Physical therapy (manual therapy)
Facility: Nemaha Valley Community Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $74
- Cash Discount Price: $132
- vs. Medicare Baseline: 2.67x 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 267% of the Medicare baseline (a markup of 167%). 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 | $58 | 209% |
| Humana | $65 | 234% |
| Va Ccn - All Plans | $65 | 234% |
| Aetna | $65 - $125 | 234% |
| Celtic Comm Exch - All Plans | $71 | 256% |
| Partners Direct Health - All Plans | $76 | 274% |
| Multiplan - All Plans | $132 | 476% |
| Midlands Choice - All Plans | $140 | 505% |
| Health Partners - All Plans | $140 | 505% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Nemaha Valley Community Hospital in Seneca, Kansas, the cash price of $132.00 is lower than the average negotiated rate of $76.00 paid by most insurance plans, including Blue Cross Blue Shield, Humana, and Aetna. While the facility's cash rate is higher than its own Medicare benchmark of $27.72, patients with high-deductible plans may find paying out-of-pocket cheaper than the insurance negotiated rates, which can range from $58 to $140 depending on the specific carrier. Because commercial insurance contracts often include administrative overhead that inflates the baseline price, the cash price here represents a direct comparison to the facility's self-pay rates rather than the inflated list charges.
To ensure you receive the best possible rate, it is important to verify if the hospital offers "self-pay" or "prompt-pay" discounts before scheduling your visit, as these upfront incentives can significantly reduce the final cost. If you do receive a bill from an out-of-network provider or encounter unexpected charges, you have the right to request an itemized audit to identify errors such as double-billing or unbundled codes, which are common in hospital billing. Additionally, under the No Surprises Act, you are protected from balance billing for emergency care and non-emergency services at in-network facilities, so any surprise charges should be disputed immediately with the insurer or facility billing supervisor.