Physical therapy (therapeutic exercise)
Facility: Graham County Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $50
- Cash Discount Price: $66
- vs. Medicare Baseline: 1.72x 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.
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 |
|---|---|---|
| Medicare (plans) | $40 - $58 | 138% |
| UnitedHealthcare | $42 - $74 | 145% |
| Celtic Commercial-All Other Plans | $44 - $64 | 151% |
| Medicaid / KanCare | $45 | 155% |
| Blue Cross Blue Shield | $49 | 169% |
| Wppa (Providers Care)-All Plans | $50 - $74 | 172% |
Consumer Guidance & Cost Commentary
For this physical therapy session at Graham County Hospital in Hill City, KS, the cash price is $66.00, which matches the facility's cash median. This rate is significantly higher than the state average for this service, as indicated by a 1.7x markup compared to Medicare's benchmark rate of $29.06. While commercial insurance plans like UnitedHealthcare and Wppa (Providers Care) have negotiated rates ranging from $42 to $74, these amounts often exceed the cash price due to administrative costs and contract structures. Patients with high-deductible plans may find it financially advantageous to pay the $66.00 cash rate directly, as the insurance negotiated ceiling can sometimes be higher than the out-of-pocket cash cost.
To ensure you are receiving the best possible rate, it is important to verify if the facility offers "self-pay" or "prompt-pay" discounts before scheduling your visit, as these can reduce the final bill by 20% to 50%. Additionally, while the facility is in-network for many payers, patients should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under federal law. If you receive an itemized bill, request a full line-by-line audit to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies that can be corrected. Always compare the final allowed amount to the Medicare benchmark to understand the true cost of care relative to the facility's pricing.