Physical therapy (therapeutic exercise)
Facility: Clara Barton Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $73
- Cash Discount Price: $63
- vs. Medicare Baseline: 2.51x 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 251% of the Medicare baseline (a markup of 151%). 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 | $49 | 169% |
| 6 Degrees Health - All Plans | $57 - $69 | 196% |
| Wppa-All Plans | $65 - $79 | 224% |
| UnitedHealthcare | $73 - $89 | 251% |
| Aetna | $73 - $89 | 251% |
| Phcs - All Plans | $73 - $89 | 251% |
| Hlth Partners Of Ks-All Plans | $75 - $91 | 258% |
Consumer Guidance & Cost Commentary
For this Physical therapy (therapeutic exercise) service at Clara Barton Hospital in Hoisington, KS, the cash price of $63.00 is notably lower than the facility's negotiated rates, which range from $49.00 to $91.00 depending on the insurance plan. While the median negotiated rate across payers is $74.00, patients with high-deductible plans may find the cash price more advantageous if their insurance allows a higher allowed amount than the cash rate. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash price does not automatically guarantee the lowest possible cost; patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final bill by bypassing administrative processing costs.
When evaluating the value of this service, it is essential to compare rates against the Medicare benchmark rather than the hospital's gross chargemaster list. The Medicare amount for this code is $29.06, and the facility's cash rate of $63.00 represents a markup of 2.5 times the Medicare rate, which falls within the range of fair pricing typically defined as 120% to 150% of Medicare. Although commercial negotiated rates often average 200% to 300% of Medicare, the specific contracts here result in a median negotiated payment of $73.00. To ensure you are not overcharged, always request an itemized billing audit before paying, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered, and