Physical therapy (manual therapy)
Facility: Holton Community Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $57
- Cash Discount Price: $55
- vs. Medicare Baseline: 2.06x 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 206% of the Medicare baseline (a markup of 106%). 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 |
|---|---|---|
| UnitedHealthcare | $34 - $100 | 123% |
| Aetna | $34 - $81 | 123% |
| Kansas Superior Select - All Plans | $35 - $44 | 126% |
| Humana | $35 - $43 | 126% |
| Blue Cross Blue Shield | $38 - $50 | 137% |
| Preferred Health Freedom | $54 - $67 | 195% |
| Preferred Health Professionals | $54 - $67 | 195% |
| Preferred Health Fn Select - All Other Plans | $54 - $67 | 195% |
| Wppa Providers - All Plans | $62 - $77 | 224% |
| Medicaid / KanCare | $65 - $81 | 234% |
Consumer Guidance & Cost Commentary
For CPT code 97140, Physical therapy (manual therapy), Holton Community Hospital in Holton, KS (ZIP 66436) lists a cash median price of $55.00, which is lower than the facility's negotiated rates of $57.00 and the gross charge of $73.00. This service is provided at a Critical Access Hospital, a facility type often subject to specific federal payment rules. While the facility is a voluntary non-profit, patients should be aware that cash payments can sometimes be more cost-effective than using insurance, particularly if the patient's plan has a high deductible or if the insurance negotiated rate exceeds the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce the out-of-pocket cost.
When using insurance, the allowed amounts vary significantly across payers, ranging from a low of $34 to a high of $100, with the highest negotiated rate reaching $81 for Medicaid/KanCare plans. Because commercial insurance rates often include administrative overhead and contract markups, they can exceed the cash price; for instance, the cash median of $55.00 is notably lower than the median negotiated rate of $57.00. To avoid unexpected balance billing or errors, patients should request a full itemized bill showing specific CPT codes rather than accepting summary invoices, and they should verify their deductible status before proceeding. If a surprise bill arises, consumers should dispute it in writing and request a No Surprises Act audit, as federal protections generally prevent out-of-network providers from billing the full