Physical therapy (therapeutic exercise)
Facility: Hiawatha Community Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $58
- Cash Discount Price: $133
- vs. Medicare Baseline: 2.00x 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 |
|---|---|---|
| UnitedHealthcare | $22 - $177 | 76% |
| Aetna | $22 - $166 | 76% |
| Humana | $22 - $77 | 76% |
| Ambetter / Centene | $26 - $91 | 89% |
| Centrus Health Direct - All Plans | $44 - $154 | 151% |
| Oscar - All Plans | $44 - $154 | 151% |
| Preferred Hlth - All Plans | $53 - $185 | 182% |
| Blue Cross Blue Shield | $54 - $57 | 186% |
| Wppa Providrs Care - All Plans | $56 - $196 | 193% |
| Cigna | $56 - $196 | 193% |
| Multiplan - All Plans | $57 - $200 | 196% |
| Midlands Choice - All Plans | $57 - $200 | 196% |
| Healthy Blue Mcaid - All Plans | $59 - $206 | 203% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy services, Hiawatha Community Hospital in Hiawatha, KS, lists a cash price of $133.00. This cash rate is significantly higher than the facility's negotiated rates, which range from a low of $22 to a high of $206 depending on the insurance plan. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. In this specific case, the cash price of $133.00 is notably lower than the median negotiated amount of $58.00 reported for this service, suggesting that paying out-of-pocket might be more cost-effective than using insurance for this particular procedure, especially if the patient has a high deductible or is self-pay.
The facility's pricing is benchmarked against federal standards, with a Medicare amount of $29.06. The cash price of $133.00 represents a markup of 2.0 times the Medicare rate, which falls within the typical range where commercial rates can vary widely. To minimize costs, patients are encouraged to verify their specific plan's allowed amount before scheduling, as some in-network plans may pay significantly less than the facility's cash rate. Additionally, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront. Since over 80% of hospital bills contain errors, it is also advisable to request an itemized statement to ensure all charges are accurate before