Physical therapy (therapeutic exercise)
Facility: Lane County Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $90
- Cash Discount Price: $90
- vs. Medicare Baseline: 3.10x 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 310% of the Medicare baseline (a markup of 210%). 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 |
|---|---|---|
| Aetna | $81 - $86 | 279% |
| UnitedHealthcare | $81 - $90 | 279% |
| Healthy Blue Mcaid | $90 | 310% |
| Healthy Blue Mcr Adv - All Other Plans | $90 | 310% |
| Medicaid / KanCare | $90 - $99 | 310% |
| Wppa Providers-All Plans | $135 | 465% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), the cash and negotiated rates at Lane County Hospital in Dighton are both $90.00, which matches the state average. This facility, a Critical Access Hospital owned by a Government Hospital District, lists a Medicare amount of $29.06. While the cash price is significantly higher than the Medicare benchmark, it aligns with the median paid amount of $90.00 reported for this procedure. Patients should note that while cash payment here equals the negotiated rate, this dynamic can vary; in some cases, paying cash directly may be cheaper than insurance if the insurer's negotiated rate exceeds the cash price, though this is not the case for this specific code at this facility.
The data indicates that commercial payers have negotiated rates ranging from $81 to $99, with specific plans like Aetna and UnitedHealthcare showing a range of $81 to $90. Medicaid/KanCare plans show a range of $90 to $99. Because the cash and negotiated rates are identical at $90.00, patients with high-deductible plans might find that paying out-of-pocket avoids the administrative costs associated with insurance processing, provided they have met their deductible. It is important to verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as hospitals often offer fee reductions for upfront payment to bypass claims processing. Given that the cash rate matches the negotiated rate, there is no immediate financial advantage to using insurance for this specific service at this location, but patients should always confirm their specific plan's allowed amount prior to treatment.