Physical therapy (therapeutic exercise)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $75
- Cash Discount Price: $66
- vs. Medicare Baseline: 2.58x 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 258% of the Medicare baseline (a markup of 158%). 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 | $47 - $49 | 162% |
| UnitedHealthcare | $75 - $83 | 258% |
| Providers Care (Wppa)-All Plans | $145 | 499% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), the facility's cash median rate is $66.00, while the median negotiated rate paid by insurance is $75.00. This indicates that for patients with high-deductible plans or those seeking immediate payment, paying cash directly may be more cost-effective than using insurance, as the cash price is lower than the insurer's allowed amount. However, patients should verify their specific plan details, as some policies may cover the full negotiated rate even if the cash price is lower.
The facility's pricing is significantly higher than the Medicare benchmark, which stands at $29.06 for this service. While the data does not provide explicit state or county average comparisons, the substantial markup above the Medicare rate highlights the importance of understanding the difference between the hospital's gross charges and the actual reimbursement rates. To minimize potential balance billing, patients should confirm their network status and request a prompt-pay discount if they choose to pay out-of-pocket, ensuring they are not billed the difference between the chargemaster and their insurance allowed amount.