Physical therapy (therapeutic exercise)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $61
- Cash Discount Price: $65
- vs. Medicare Baseline: 2.10x 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 210% of the Medicare baseline (a markup of 110%). 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 | $52 | 179% |
| Humana | $59 | 203% |
| Aetna | $60 - $65 | 206% |
| Hpk-All Plans | $61 | 210% |
| UnitedHealthcare | $61 | 210% |
| Medicaid / KanCare | $65 | 224% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing therapeutic exercise at Medicine Lodge Memorial Hospital, the cash price is $65.00, which matches the facility's negotiated rate for most payers. This cash price is notably higher than the Medicare benchmark of $29.06, indicating a markup of 2.1 times the federal rate. While the facility is a Critical Access Hospital in Medicine Lodge, KS, the data provided does not include specific county or state average comparisons for this service. Patients should note that while commercial insurance plans like Aetna and Humana negotiate rates between $59 and $65, these amounts often exceed the cash price, meaning paying out-of-pocket could result in lower out-of-pocket costs for those with high deductibles or no coverage.
To minimize costs, patients should proactively contact the hospital to inquire about self-pay or prompt-pay discounts, which can reduce the bill by 20% to 50% when paid upfront. It is important to request a waiver of insurance submission before scheduling to prevent automatic claims processing, which would void any cash discount agreement. Additionally, since over 80% of hospital bills contain errors, patients should request a detailed, itemized CPT-coded statement rather than accepting a summary bill. If a balance bill arises from out-of-network ancillary services, the No Surprises Act may provide protections against unexpected charges, and patients should dispute any bills that do not align with the negotiated or cash rates listed above.