Physical therapy (manual therapy)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $35
- Cash Discount Price: $61
- vs. Medicare Baseline: 1.26x 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.
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 | $28 - $50 | 101% |
| UnitedHealthcare | $34 - $35 | 123% |
| Blue Cross Blue Shield | $58 | 209% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price is $61.00, which matches the facility's median cash rate. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. In this case, the median negotiated rate across payers is $35.00, which is lower than the cash price, suggesting that using insurance may result in a lower out-of-pocket cost for those with active coverage. However, if a patient has a high-deductible plan where they would otherwise pay the full $61.00, paying cash upfront could still be more efficient if the insurance allowed amount is significantly lower than the cash rate, though the data indicates the negotiated average is already below the cash price.
The facility's pricing is benchmarked against Medicare, which sets a baseline of $27.72 for this procedure. The commercial negotiated rates are approximately 1.3 times the Medicare amount, reflecting the standard markup for in-network commercial coverage. It is important to note that while the facility offers a rating of 4, the specific pricing for this code does not appear to deviate significantly from the state or county averages provided in the dataset, as the cash and negotiated rates align closely with the reported medians. Patients are encouraged to verify their specific plan's deductible status and ask the billing department about any prompt-pay discounts or self-pay reductions before scheduling, as these incentives can further reduce the final cost.