Physical therapy (manual therapy)
Facility: Clara Barton Hospital
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $86
- Cash Discount Price: $69
- vs. Medicare Baseline: 3.10x 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 310% of the Medicare baseline (a markup of 210%). 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 | $50 | 180% |
| 6 Degrees Health - All Plans | $67 - $71 | 242% |
| Wppa-All Plans | $77 - $82 | 278% |
| Phcs - All Plans | $86 - $92 | 310% |
| Aetna | $86 - $92 | 310% |
| UnitedHealthcare | $86 - $92 | 310% |
| Hlth Partners Of Ks-All Plans | $88 - $94 | 317% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Clara Barton Hospital in Hoisington, KS, the cash price is $69.00, which is significantly lower than the facility's negotiated rates of $86.00 and the state average of $86.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate exceeds this amount. It is important to note that commercial rates often include administrative overhead and contract dynamics that can inflate the baseline price, so comparing directly to the cash price or the Medicare benchmark of $27.72 provides a clearer picture of the actual cost.
Consumers should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services are billed separately. To avoid potential overcharges, patients are encouraged to request a full itemized billing audit before paying, as summary bills often obscure individual line items and unbundled codes. Additionally, asking the hospital about "self-pay" or "prompt-pay" discounts prior to scheduling can help secure immediate fee reductions, as these programs are designed to offer upfront payment incentives that bypass costly insurance billing cycles.