Physical therapy (therapeutic exercise)
Facility: Nmc Health
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $91
- Cash Discount Price: $94
- vs. Medicare Baseline: 3.13x 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 313% of the Medicare baseline (a markup of 213%). 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 |
|---|---|---|
| Bluestem Pace | $28 | 96% |
| Medicaid / KanCare | $44 | 151% |
| Leading Age | $44 | 151% |
| Wppa | $56 - $87 | 193% |
| Blue Cross Blue Shield | $57 | 196% |
| Occunet | $61 - $95 | 210% |
| Aetna | $62 - $123 | 213% |
| Samaritan Ministries International | $66 - $103 | 227% |
| Medincrease Health Plan | $66 - $103 | 227% |
| Prime Health Services | $76 - $119 | 262% |
| UnitedHealthcare | $91 - $142 | 313% |
| Cigna | $96 - $150 | 330% |
Consumer Guidance & Cost Commentary
For the Physical therapy (therapeutic exercise) service (CPT 97110) at Nmc Health in Newton, Kansas, the cash price is $94.00, which is notably lower than the facility's negotiated rates for most commercial payers. While the facility's cash rate is $64.94 higher than the state average of $29.06, it remains significantly below the negotiated ceilings for major insurers like UnitedHealthcare ($142.00), Cigna ($150.00), and Aetna ($123.00). This pricing structure suggests that for patients with high-deductible plans who have not yet met their coverage thresholds, paying the cash price directly could result in lower out-of-pocket costs compared to the insurance negotiated rates that commercial carriers are contractually obligated to pay.
Patients should verify their specific plan details before scheduling, as the facility's cash rate of $94.00 is also lower than the median negotiated amount of $91.00 reported for this service in the region. Although the facility is an Acute Care Hospital with a voluntary non-profit ownership structure, the wide variance in allowed amounts across payers—ranging from $28.00 for Bluestem Pace to $150.00 for Cigna—highlights the importance of confirming your deductible status and asking about self-pay or prompt-pay discounts prior to check-in. To ensure you are not overpaying, request a full itemized bill to review the specific CPT codes and avoid balance billing, while keeping in mind that Medicare's benchmark rate of $29.06 serves as the objective baseline for evaluating