Physical therapy (therapeutic exercise)
Facility: Rooks County Health Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $93
- Cash Discount Price: $78
- vs. Medicare Baseline: 3.20x 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 320% of the Medicare baseline (a markup of 220%). 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 |
|---|---|---|
| Veterans Admin - All Plans | $49 | 169% |
| Tricare | $49 | 169% |
| Celtic Mcr Adv | $49 | 169% |
| Celtic Comm - All Other Plans | $54 | 186% |
| Blue Cross Blue Shield | $57 | 196% |
| Preferred Benefits Admin | $93 | 320% |
| Aetna | $93 | 320% |
| UnitedHealthcare | $93 | 320% |
| Preferred Hlthcare - All Other Plans | $98 | 337% |
| Health Partners - All Plans | $98 | 337% |
| Healthy Blue Mcaid - All Plans | $104 | 358% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy services, Rooks County Health Center in Plainville, KS, lists a gross charge of $104.00. The facility's cash median price is $78.00, while the median negotiated rate for commercial payers is $93.00. This facility is a Critical Access Hospital owned by a Government Hospital District. When comparing these figures to the national baseline, the facility's cash price is 3.2% higher than the Medicare benchmark of $29.06. While the data provided does not include specific state or county average figures for this procedure, patients should note that cash payments can sometimes be more cost-effective than insurance claims, particularly for those with high-deductible plans where the negotiated rate might exceed the out-of-pocket cash cost.
It is important to distinguish between the gross charge and the actual amount billed to a patient. The gross charge of $104.00 is the maximum amount the hospital could bill, but commercial payers like Aetna, UnitedHealthcare, and Blue Cross Blue Shield have negotiated a fixed rate of $93.00 for this service. Patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary significantly even within the same facility. To potentially lower costs, patients should ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. Additionally, since over 80% of hospital bills often contain errors, patients should request a detailed, itemized statement to ensure no charges are double-billed or for