Physical therapy (therapeutic exercise)
Facility: Ellsworth County Medical Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $66
- Cash Discount Price: $74
- 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 | $32 - $74 | 110% |
| Va Ccn-All Plans | $32 - $37 | 110% |
| Triwest -All Plans | $32 - $37 | 110% |
| Healthy Blue Mcr Adv | $32 - $37 | 110% |
| UnitedHealthcare | $45 - $78 | 155% |
| Blue Cross Blue Shield | $47 - $49 | 162% |
| First Health - All Plans | $62 - $70 | 213% |
| Aetna | $62 - $70 | 213% |
| Cigna | $66 - $74 | 227% |
| Healthy Blue Mcaid- All Other Plans | $69 - $78 | 237% |
| Medicaid / KanCare | $69 - $78 | 237% |
| Coventry Mcaid-All Plans | $69 - $78 | 237% |
| Providers Care-Wppa-All Plans | $104 - $117 | 358% |
Consumer Guidance & Cost Commentary
For this Physical therapy (therapeutic exercise) service at Ellsworth County Medical Center, the cash price is $74.00, which matches the facility's cash median. While the Medicare benchmark for this procedure is $29.06, the negotiated rates paid by various insurers range from $32 to $117, with a median negotiated amount of $66.00. This indicates that for many patients, paying cash directly could result in lower out-of-pocket costs compared to using insurance, as the insurance negotiated rates often exceed the cash price. It is important to note that while the facility is a Critical Access Hospital in Ellsworth, KS, the specific county or state average data for this code was not provided in the available information, so comparisons to broader regional averages cannot be made.
Patients should be aware that commercial insurance rates often include administrative overhead and contract dynamics that can inflate the baseline price, sometimes reaching 200% to 300% of the Medicare rate, whereas fair pricing is typically defined as 120% to 150% of Medicare. In this case, the facility's cash rate of $74.00 is significantly lower than the median negotiated rate of $66.00 for some payers but higher than the lowest negotiated rates of $32.00 to $37.00. To potentially reduce costs, patients should inquire about "self-pay" or "prompt-pay" discounts before scheduling, as hospitals often offer fee reductions for upfront payment to bypass costly claims processing. Additionally, if a patient receives care from an out-of-network provider, they may face balance billing for the difference between the provider's full charge and the