Physical therapy (therapeutic exercise)
Facility: Susan B Allen Memorial Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $554
- Cash Discount Price: $79
- vs. Medicare Baseline: 19.06x 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 $29.06 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 1906% of the Medicare baseline (a markup of 1806%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 1204% |
| Providrs Care | $757 | 2605% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Susan B Allen Memorial Hospital in El Dorado, KS, lists a cash median price of $79.00, which is significantly lower than the facility's gross charge of $122.00. While the facility's negotiated rates with UnitedHealthcare and Providrs Care are $350 and $757 respectively, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket if they qualify for a self-pay or prompt-pay discount. It is important to note that commercial insurance rates frequently include administrative overhead and contract markups, sometimes reaching 200% to 300% of the Medicare benchmark rate of $29.06, whereas fair pricing is typically defined as 120% to 150% of this baseline.
Patients should be aware of balance billing risks if they receive care from out-of-network providers, where the hospital could bill the difference between the full chargemaster and the insurance allowed amount, though the No Surprises Act protects against this for emergency and non-emergency services at in-network facilities. To avoid unexpected costs, consumers should request an itemized billing audit to verify that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. Before scheduling, it is advisable to confirm the facility's status with UnitedHealthcare and Providrs Care, check for prompt-pay discounts that could reduce the bill by 20% to 50%, and ensure any consent forms do not inadvertently waive rights to dispute out-of-network charges.