Physical therapy (therapeutic exercise)
Facility: Cloud County Health Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $121
- Cash Discount Price: $92
- vs. Medicare Baseline: 4.16x 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 416% of the Medicare baseline (a markup of 316%). 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 |
|---|---|---|
| Aetna | $114 - $126 | 392% |
| Mpi-All Plans | $120 - $128 | 413% |
| Health Partners - All Plans | $120 - $128 | 413% |
| Pponext-All Plans | $120 - $128 | 413% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Cloud County Health Center in Concordia, KS, lists a gross charge of $131.00. While the facility's cash median rate is $92.00, which is lower than the state average of $124.00, patients with high-deductible plans should consider that paying cash upfront might be more cost-effective than using insurance. In this case, the median negotiated rate across four payers is $121.00, which exceeds the cash price. This illustrates a common billing dynamic where commercial insurance contracts often result in higher out-of-pocket costs for patients who have not yet met their deductible, whereas paying directly can bypass these administrative layers.
It is important to note that the facility's cash rate of $92.00 is significantly lower than the Medicare benchmark of $29.06 for this service, indicating a substantial markup relative to the federal baseline. To minimize costs, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often offer fee reductions of 20% to 50% for upfront payments that bypass claims processing. Additionally, because the No Surprises Act prohibits balance billing for emergency care and non-emergency services at in-network facilities, patients should verify that all ancillary services are covered under the facility's network agreements to avoid unexpected secondary bills.