Physical therapy (therapeutic exercise)
Facility: Wilson Medical Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $90
- Cash Discount Price: $85
- vs. Medicare Baseline: 3.10x 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 310% of the Medicare baseline (a markup of 210%). 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 - $113 | 169% |
| Tricare | $60 | 206% |
| Humana | $60 | 206% |
| UnitedHealthcare | $60 - $105 | 206% |
| Aetna | $60 - $113 | 206% |
| Ambetter / Centene | $60 - $113 | 206% |
| Cigna | $90 | 310% |
| Health Partners-All Plans | $104 | 358% |
| Mulitplan-All Plans | $104 | 358% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing therapeutic exercise at Wilson Medical Center in Neodesha, Kansas, the facility's cash median rate is $85.00, which is notably lower than the state average of $113.00. While the facility's negotiated rates range from $60.00 to $113.00 across nine payers, the cash price offers a distinct advantage for patients with high-deductible plans or those without insurance, as it avoids the administrative overhead often embedded in commercial contracts. It is important to note that while the facility is a Critical Access Hospital owned by the local government, patients should verify their specific plan's allowed amount before scheduling, as some commercial payers may negotiate rates that exceed the cash price, potentially resulting in higher out-of-pocket costs if the patient's deductible is not yet met.
To ensure you are not overcharged, it is recommended to request a full itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you are an out-of-network patient receiving care at this in-network facility, you may be protected from balance billing for emergency and non-emergency services under the No Surprises Act, though you should still dispute any unexpected charges in writing. Finally, since the cash median of $85.00 is lower than the facility's median negotiated rate of $90.00, you should explicitly ask the billing department about prompt-pay discounts or self-pay rates before finalizing your payment to secure the most favorable price available.