Physical therapy (therapeutic exercise)
Facility: Ellinwood District Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $49
- Cash Discount Price: $60
- vs. Medicare Baseline: 1.69x 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.
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 |
|---|---|---|
| Aetna | $49 | 169% |
| Blue Cross Blue Shield | $49 | 169% |
| Humana | $49 | 169% |
| Cigna | $49 | 169% |
| UnitedHealthcare | $49 | 169% |
Consumer Guidance & Cost Commentary
For CPT code 97110, representing physical therapy (therapeutic exercise), the facility in Ellinwood, KS, has a cash median price of $60.00 and a median negotiated rate of $49.00 across five payers, including Aetna, Blue Cross Blue Shield, Humana, Cigna, and UnitedHealthcare. While the negotiated rate is lower than the cash price, patients with high-deductible plans may find paying the cash price of $60.00 more cost-effective if their insurance allowed amount exceeds this figure, as they would avoid out-of-pocket costs until their deductible is met. It is important to verify your specific plan's allowed amount before scheduling, as in-network rates vary significantly by carrier and can sometimes be higher than the cash-pay option.
The facility's pricing is benchmarked against the Medicare rate of $29.06, showing a markup factor of 1.7 relative to the federal baseline. This comparison highlights that commercial rates often exceed the true cost of care, which is calculated using local wage indexes and provider cost reports. To ensure you are not overpaying, request an itemized billing audit before finalizing payment, as summary bills can obscure errors or unbundled charges. Additionally, ask the hospital about prompt-pay discounts, which can reduce the total cost by 20% to 50% if you settle the bill upfront, bypassing the administrative overhead associated with insurance claims processing.