Physical therapy (manual therapy)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $77
- Cash Discount Price: $68
- vs. Medicare Baseline: 2.78x 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 278% of the Medicare baseline (a markup of 178%). 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 | $48 - $50 | 173% |
| UnitedHealthcare | $76 - $85 | 274% |
| Providers Care (Wppa)-All Plans | $149 | 538% |
Consumer Guidance & Cost Commentary
For the CPT code 97140, representing physical therapy with manual therapy, the facility's cash median rate is $68.00, which is lower than the negotiated rates paid by major payers like UnitedHealthcare ($76.00 to $85.00) and Providers Care ($149.00). This pricing structure highlights a common billing dynamic where commercial insurance contracts often exceed cash prices due to administrative overhead and multi-layered contract structures. For patients with high-deductible plans, paying the cash price of $68.00 upfront can be more cost-effective than relying on insurance, especially if the negotiated rate exceeds the cash amount. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing the costly claims processing cycle that inflates insurance rates.
When evaluating the value of this service, it is important to compare the facility's rates against the Medicare benchmark rather than the inflated chargemaster list. The Medicare amount for this procedure is $27.72, and the facility's cash rate of $68.00 represents a markup of 2.8 times the Medicare rate. While commercial negotiated rates often average 200% to 300% of Medicare, fair pricing is typically defined as 120% to 150% of the Medicare baseline. To ensure you are not overpaying, request a full itemized CPT-coded bill before paying, as summary bills often obscure individual line items and potential errors. If you receive a large bill after insurance processing, dispute any charges for services not rendered or unbundled components in writing