Physical therapy (therapeutic exercise)
Facility: F W Huston Medical Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $85
- Cash Discount Price: $88
- vs. Medicare Baseline: 2.92x 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 292% of the Medicare baseline (a markup of 192%). 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% |
| Aetna | $82 | 282% |
| Humana | $87 | 299% |
| Cigna | $94 | 323% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy therapeutic exercise at F W Huston Medical Center in Winchester, KS, the facility's cash median rate is $88.00, which is lower than the state average of $110.00. While the facility's negotiated rates with major payers like Blue Cross Blue Shield ($49), Aetna ($82), and Humana ($87) are significantly lower than the gross charge, these amounts remain higher than the cash price. This pricing structure suggests that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash rate of $88.00 directly may result in lower total costs compared to using insurance, which would require the patient to cover the difference between the negotiated rate and their deductible.
The facility's median paid amount of $87.00 is slightly below the cash rate, indicating that insurance reimbursement is nearly equivalent to self-pay in this specific case. However, patients should verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing administrative claim processing fees. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the final amount owed depends entirely on your specific insurance plan's deductible and copayment status. To ensure you are receiving the most accurate pricing, always request an itemized bill before payment to confirm that no unbundled codes or services not rendered are included in the total.