Physical therapy (manual therapy)
Facility: Clay County Medical Center
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $84
- Cash Discount Price: $88
- vs. Medicare Baseline: 3.03x 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 303% of the Medicare baseline (a markup of 203%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $82 | 296% |
| Aetna | $82 | 296% |
| Health Partners - All Plans | $84 | 303% |
| Multiplan- All Plans | $84 | 303% |
| UnitedHealthcare | $84 | 303% |
Consumer Guidance & Cost Commentary
For CPT code 97140, Physical therapy (manual therapy), Clay County Medical Center in Clay Center, KS, lists a cash median price of $88.00, which matches the facility's negotiated rate of $84.00 for in-network payers like Aetna and UnitedHealthcare. This cash price is notably higher than the state average for this service, though it aligns closely with the specific negotiated rates observed across the five major payers in this dataset. While commercial insurance contracts often cap charges at negotiated rates, patients with high-deductible plans may find the cash price more favorable if their insurance allowed amount exceeds $88.00, as paying out-of-pocket avoids the administrative fees and markup layers inherent in the insurance billing cycle.
To ensure you are receiving the most accurate pricing, it is critical to request an itemized billing audit before finalizing payment, as summary bills often obscure individual line items and potential errors. Additionally, since this facility is a Critical Access Hospital with government-local ownership, you should explicitly inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final balance by 20% to 50% if settled upfront. When comparing costs, always benchmark against the Medicare rate of $27.72 rather than the hospital's gross chargemaster; while the commercial negotiated rate of $84.00 represents a significant markup relative to Medicare, it reflects the contractual agreements and administrative costs required to process claims for commercial insurers.