Physical therapy (manual therapy)
Facility: Clearsky Rehabilitation Hospital Of Elwood St Joseph Llc
Billing Code: 97140 (CPT)
- CPT Billing Code: 97140
- Insurance Median: $39
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.41x 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 |
|---|---|---|
| Multiplan | $32 - $44 | 115% |
| Cigna | $35 - $49 | 126% |
Consumer Guidance & Cost Commentary
For this Physical therapy (manual therapy) service at Clearsky Rehabilitation Hospital Of Elwood St Joseph Llc, the negotiated rates paid by major insurers like Multiplan and Cigna range from $32 to $49, which is significantly higher than the facility's cash price of $60.00. While the facility's negotiated rates are 1.4 times the Medicare benchmark of $27.72, indicating a standard commercial markup, the cash price remains the most transparent figure available. Patients with high-deductible plans or those without insurance may find it financially advantageous to pay the cash rate directly, as it avoids the administrative overhead and higher negotiated fees that insurance carriers charge. It is important to note that while the facility is a Part A Provider in Elwood, KS, the specific cash or self-pay discount amount is not listed in the current data, so patients should contact the hospital directly to confirm if a "prompt-pay" discount is available before scheduling.
The data indicates that this service is billed under CPT code 97140, with no specific state or county average provided for comparison in this report. However, the facility's negotiated rates of $32 to $49 reflect the typical administrative load and contract dynamics where commercial payers cover costs plus processing fees. If a patient receives care from an out-of-network provider at this facility, they could face balance billing for the difference between the provider's full charge and the insurance allowed amount, though the No Surprises Act protects against such surprise bills for emergency and non-emergency services at in-network facilities. To ensure accuracy, patients should request an itemized bill to verify that all charges are correctly coded and that no services were unbundled or