Physical therapy (manual therapy)
Facility: Decatur Health
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $88
- Cash Discount Price: $103
- vs. Medicare Baseline: 3.17x 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 317% of the Medicare baseline (a markup of 217%). 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 | $65 | 234% |
| Wppa/Providrs Care- All Plans | $69 | 249% |
| UnitedHealthcare | $70 - $88 | 253% |
| Humana | $71 | 256% |
| Aetna | $103 - $115 | 372% |
| Midlands Choice- All Plans | $103 | 372% |
| Medicaid / KanCare | $116 | 418% |
Consumer Guidance & Cost Commentary
For the CPT code 97140, representing physical therapy with manual therapy at Decatur Health in Oberlin, Kansas, the cash median price is $103.00, which is 3.2% higher than the Medicare benchmark of $27.72. While the facility's negotiated rates with major payers like UnitedHealthcare range from $70 to $88, and Aetna ranges from $103 to $115, these amounts often exceed the cash price for patients with high-deductible plans. Because insurance billing involves complex administrative processing that can add significant overhead, paying cash upfront may result in a lower out-of-pocket cost compared to the final allowed amount after insurance adjudication.
Patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling services to avoid being billed the full negotiated rate. Although Decatur Health is a Voluntary non-profit Critical Access Hospital, the data does not indicate specific self-pay discounts in the current report, so it is essential to confirm these options directly with the billing department. Additionally, while the facility is located in the 67749 zip code, the provided data does not include specific county or state average comparisons for this procedure, so the $103.00 cash median should be viewed as the primary benchmark for direct payment.