Physical therapy (manual therapy)
Facility: Cloud County Health Center
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $117
- Cash Discount Price: $89
- vs. Medicare Baseline: 4.22x 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 422% of the Medicare baseline (a markup of 322%). 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 |
|---|---|---|
| Aetna | $100 - $133 | 361% |
| Health Partners - All Plans | $105 - $136 | 379% |
| Pponext-All Plans | $105 - $136 | 379% |
| Mpi-All Plans | $105 - $136 | 379% |
Consumer Guidance & Cost Commentary
For the CPT code 97140, representing physical therapy with manual therapy, the gross charge at Cloud County Health Center in Concordia, KS, is $127.00. This facility, a voluntary non-profit Critical Access Hospital, reports a cash median of $89.00 and a median negotiated rate of $117.00 across four payers, including Aetna, Health Partners, Pponext, and Mpi. While the facility's cash price is lower than its negotiated rates, it is important to note that commercial negotiated rates often include administrative overhead and do not reflect the true cost of care. For patients with high-deductible plans, paying the cash price of $89.00 upfront may be more cost-effective than relying on insurance, which could result in a higher out-of-pocket expense if the deductible has not yet been met. Additionally, patients should inquire about prompt-pay discounts, which can further reduce the final bill by paying in full within a specified window, bypassing the administrative costs associated with insurance claims processing.
The pricing data for this service is benchmarked against Medicare, which sets a fixed reimbursement rate of $27.72 for this procedure. The facility's cash median of $89.00 represents a 4.2x markup compared to the Medicare amount, illustrating the significant difference between federal cost-based reimbursement and commercial pricing structures. While the provided data does not include specific state or county average comparisons for this exact code, the facility's location in the 66901 zip code suggests local market dynamics that may influence these rates. To ensure transparency, patients are advised to request an itemized bill before scheduling services to