Physical therapy (therapeutic exercise)
Facility: Rawlins County Health Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $96
- Cash Discount Price: $94
- vs. Medicare Baseline: 3.30x 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 330% of the Medicare baseline (a markup of 230%). 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 | $49 | 169% |
| UnitedHealthcare | $96 | 330% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy therapeutic exercise, the Rawlins County Health Center lists a cash price of $94.00, which is lower than the facility's negotiated rates of $96.00 and $96.00 for UnitedHealthcare and Blue Cross Blue Shield, respectively. While the facility is a Critical Access Hospital in Atwood, Kansas, with a gross charge of $110.00, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance negotiated rate exceeds the cash price. It is important to note that commercial negotiated rates often include administrative overhead and can be significantly higher than the true cost of care, which is better reflected by the Medicare benchmark of $29.06.
To minimize unexpected costs, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront payment options can bypass costly insurance billing cycles and administrative fees. Although the data does not provide a specific county or state average for comparison, understanding that Medicare rates serve as a scientifically validated baseline for the "true cost" of delivery helps contextualize the facility's pricing. If you receive a bill that includes charges for services not rendered or unbundled components, you have the right to request a formal itemized audit to identify errors and avoid balance billing, especially given federal protections against surprise bills for out-of-network services at in-network facilities.