Physical therapy (therapeutic exercise)
Facility: Hamilton County Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $91
- Cash Discount Price: $101
- vs. Medicare Baseline: 3.13x 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 313% of the Medicare baseline (a markup of 213%). 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 | $23 - $57 | 79% |
| First Health Coventry - All Plans | $86 | 296% |
| Cigna | $96 | 330% |
| UnitedHealthcare | $96 | 330% |
| Va Ccn - All Plans | $101 | 348% |
| Aetna | $172 | 592% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Hamilton County Hospital in Syracuse, KS, lists a cash median price of $101.00, which matches the facility's gross charge. This cash rate is significantly higher than the state average for this service, as indicated by a 3.1x multiplier relative to the Medicare benchmark of $29.06. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, Aetna's negotiated rate is $172.00, and First Health Coventry's rate is $86.00, both of which are higher than the cash-pay option. Consequently, individuals with high-deductible plans or those who have met their out-of-pocket limits may find that paying the $101.00 cash price directly is more cost-effective than relying on insurance, which could result in balance billing if the provider is out-of-network or if ancillary services are not covered under the contract.
To minimize unexpected costs, patients should proactively request a self-pay or prompt-pay discount before scheduling any appointments, as these upfront payment incentives can bypass the costly insurance claims cycle and reduce the final bill by 20% to 50%. It is also critical to demand a full itemized billing audit rather than accepting a summary bill, since over 80% of hospital invoices contain errors such as unbundled codes or charges for services not rendered. If a patient receives a balance bill from an out-of-network provider, they should not pay immediately out of fear of