Physical therapy (therapeutic exercise)
Facility: Stafford County Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $66
- Cash Discount Price: $68
- 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 |
|---|---|---|
| Health Partners-All Plans | $62 - $66 | 213% |
| Humana | $65 - $70 | 224% |
| UnitedHealthcare | $65 - $70 | 224% |
| Va Ccn-All Plans | $65 - $70 | 224% |
| Medica Mcr- All Plans | $65 - $70 | 224% |
Consumer Guidance & Cost Commentary
For this physical therapy service at Stafford County Hospital, the cash price of $68.00 is significantly lower than the facility's gross charge of $68.00 and the median negotiated rate of $66.00 paid by insurers like Health Partners and Humana. While the cash price matches the gross amount, it remains notably higher than the state of Kansas average for this procedure, which is approximately $29.06 based on Medicare benchmarks. Patients with high-deductible plans may find the cash price more affordable than their insurance coverage, as the negotiated rates often exceed the cash price due to administrative costs and contract structures. It is advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the final amount owed.
When using insurance, be aware that the No Surprises Act protects you from balance billing for out-of-network providers at in-network facilities, though unexpected charges can still occur from ancillary services like emergency care or specific lab tests. If you receive a bill, always request a full itemized statement to verify that every charge corresponds to a service actually rendered and to identify any errors, as over 80% of hospital bills contain inaccuracies. Comparing your facility's rates to the Medicare benchmark of $29.06 reveals a substantial markup, highlighting the importance of understanding the difference between the commercial negotiated rate and the true cost of care.