Physical therapy (therapeutic exercise)
Facility: Holton Community Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $66
- Cash Discount Price: $59
- vs. Medicare Baseline: 2.27x 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 227% of the Medicare baseline (a markup of 127%). 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 |
|---|---|---|
| Humana | $42 | 145% |
| UnitedHealthcare | $42 - $100 | 145% |
| Aetna | $42 - $79 | 145% |
| Kansas Superior Select - All Plans | $43 | 148% |
| Blue Cross Blue Shield | $49 | 169% |
| Preferred Health Professionals | $66 | 227% |
| Preferred Health Freedom | $66 | 227% |
| Preferred Health Fn Select - All Other Plans | $66 | 227% |
| Wppa Providers - All Plans | $75 | 258% |
| Medicaid / KanCare | $79 | 272% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Holton Community Hospital in Holton, KS, lists a gross charge of $79.00. While the facility's cash median rate is $59.00, which is lower than the gross charge, the negotiated rates paid by major payers like UnitedHealthcare and Aetna range from $42 to $79, often matching or exceeding the cash price. It is important to note that cash payments can sometimes be more cost-effective for patients with high-deductible plans if their insurance negotiated rate exceeds the cash price. Patients should verify their specific plan's allowed amount and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront.
The facility's pricing is benchmarked against the Medicare rate of $29.06, which serves as a scientifically validated baseline for healthcare costs. The gross charge of $79.00 represents a significant markup compared to this federal standard, illustrating how commercial rates often differ from the true cost of care. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, which may hide unbundled codes or services not rendered. If a balance bill arises from an out-of-network situation, the No Surprises Act may protect patients from paying the difference between the provider's full charge and the insurance allowed amount, so it is advisable to dispute any unexpected charges in writing before making a payment.