Physical therapy (therapeutic exercise)
Facility: Ashland Health Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $100
- Cash Discount Price: $80
- vs. Medicare Baseline: 3.44x 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 344% of the Medicare baseline (a markup of 244%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $34 | 117% |
| Compalliance-All Plans | $80 | 275% |
| Health Partners Of Kansas-All Plans | $85 | 292% |
| Multiplan-All Plans | $98 | 337% |
| Medicare (plans) | $100 | 344% |
| Medicaid / KanCare | $100 | 344% |
| Healthy Blue Mcr Adv - All Other Plans | $100 | 344% |
| Medica Mcare - All Plans | $100 | 344% |
| UnitedHealthcare | $100 | 344% |
| Health Choice-All Plans | $100 | 344% |
| Aetna | $100 | 344% |
| Providers Care (Wppa)-All Plans | $150 | 516% |
Consumer Guidance & Cost Commentary
For CPT code 97110, Physical therapy (therapeutic exercise), at Ashland Health Center in Ashland, KS, the facility's cash median rate is $80.00, which is lower than the state average of $100.00. While many commercial payers, including Blue Cross Blue Shield and Compalliance-All Plans, negotiate rates of $34.00 to $85.00, these amounts often exceed the cash price. For patients with high-deductible plans, paying the $80.00 cash rate directly may result in lower out-of-pocket costs compared to having insurance cover a negotiated rate that is subsequently subject to deductibles or copays. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment options can further reduce the final amount owed.
The facility's Medicare benchmark rate for this service is $29.06, serving as a critical baseline for evaluating pricing fairness. Commercial negotiated rates across various payers, such as UnitedHealthcare and Aetna, average $100.00, which represents a significant markup over the Medicare amount. This disparity highlights the importance of understanding that commercial rates are not merely discounts off the hospital's gross charges but are instead influenced by complex administrative structures and contract dynamics. To ensure transparency and avoid unexpected costs, patients should request a detailed, itemized bill rather than accepting a summary invoice, as this allows for the identification of any unbundled codes or services not rendered. Furthermore, if a balance bill arises from an out-of-network provider, patients should verify the legality of the charge under the No