Physical therapy (manual therapy)
Facility: Goodland Regional Medical Center
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $61
- Cash Discount Price: $61
- vs. Medicare Baseline: 2.20x 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 220% of the Medicare baseline (a markup of 120%). 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% |
| Wppa | $58 - $61 | 209% |
| UnitedHealthcare | $61 | 220% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Goodland Regional Medical Center, the cash price of $61.00 is notably lower than the facility's gross charge of $68.00. While the median negotiated rate for in-network payers like Blue Cross Blue Shield, Wppa, and UnitedHealthcare is also $61.00, the cash price remains the most transparent figure for patients without insurance. It is important to note that for individuals with high-deductible plans, paying the cash price of $61.00 upfront can sometimes be more cost-effective than relying on insurance, which may result in a negotiated rate that exceeds the cash amount due to administrative overhead and contract structures. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the final cost.
When evaluating the value of this service, it is helpful to compare the facility's pricing against the Medicare benchmark, which serves as a scientifically validated baseline for healthcare costs. The Medicare amount for this procedure is $27.72, and the facility's cash rate of $61.00 represents a markup of 2.2 times the Medicare rate. While commercial negotiated rates often average between 200% and 300% of Medicare, fair pricing is typically defined as 120% to 150% of this baseline. Given that this is a Critical Access Hospital in Goodland, KS, with a facility rating of 2, patients should be aware that balance billing is generally prohibited for in-network services under the No Surprises Act, but they should still request an itemized bill to ensure no unbundled