Physical therapy (therapeutic exercise)
Facility: Kiowa District Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $102
- Cash Discount Price: $86
- vs. Medicare Baseline: 3.51x 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 351% of the Medicare baseline (a markup of 251%). 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 |
|---|---|---|
| Tricare | $42 | 145% |
| Healthchoice-All Plans | $46 | 158% |
| Blue Cross Blue Shield | $49 | 169% |
| UnitedHealthcare | $86 - $108 | 296% |
| Health Partners Of Ks-All Plans | $95 | 327% |
| Humana | $97 | 334% |
| Gbs Insurance - All Plans | $102 | 351% |
| Multiplan-All Plans | $102 | 351% |
| Aetna | $103 | 354% |
| Medicare (plans) | $103 | 354% |
| Triwest-All Plans | $103 | 354% |
| Medicaid / KanCare | $108 | 372% |
| Providers Care (Wppa)-All Plans | $162 | 557% |
| Liberty Healthshare-All Plans | $174 | 599% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing therapeutic exercise at Kiowa District Hospital, the cash price is $86.00, which matches the lowest negotiated rate found among the 14 payers listed. While the facility's cash rate aligns with the lowest insurance payments, it is important to note that many commercial payers, such as UnitedHealthcare and Providers Care, negotiate rates significantly higher than the cash price, ranging from $86.00 up to $174.00. In scenarios where a patient has a high deductible or limited insurance coverage, paying the cash price of $86.00 directly may result in lower out-of-pocket costs compared to the insurance negotiated rates, which can sometimes exceed the cash amount due to administrative overhead and contract structures.
Patients should verify if the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill. Additionally, because the facility is a Critical Access Hospital in Kansas, it is advisable to request an itemized billing audit to ensure all charges are accurate and that no unbundled codes or services not rendered are included in the final invoice. While the data does not provide specific county or state average comparisons for this specific code, understanding that commercial rates often range from 200% to 300% of the Medicare benchmark of $29.06 helps contextualize the pricing; the cash rate of $86.00 represents a fair market value relative to the Medicare baseline, avoiding the potential for balance billing that might occur with out-of-network services.