Physical therapy (therapeutic exercise)
Facility: Decatur Health
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $94
- Cash Discount Price: $111
- vs. Medicare Baseline: 3.23x 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 323% of the Medicare baseline (a markup of 223%). 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 | $64 | 220% |
| Wppa/Providrs Care- All Plans | $74 | 255% |
| UnitedHealthcare | $75 - $94 | 258% |
| Humana | $76 | 262% |
| Aetna | $111 - $123 | 382% |
| Midlands Choice- All Plans | $111 | 382% |
| Medicaid / KanCare | $124 | 427% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Decatur Health in Oberlin, KS, lists a cash median price of $111.00 and a median negotiated rate of $94.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the data indicates that the cash price is actually higher than the negotiated rate paid by commercial insurers. This dynamic suggests that for patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price of $111.00 upfront could result in lower total costs compared to using insurance, which would trigger the higher negotiated rate of $94.00 plus any applicable deductibles or copays. It is important to verify your specific plan's deductible status before scheduling, as assuming in-network coverage automatically means the lowest possible price can lead to unexpected financial burdens if your deductible has not been satisfied.
When evaluating the cost against federal benchmarks, the Medicare amount for this service is $29.06, which serves as the objective baseline for pricing. The facility's cash price of $111.00 represents a significant markup relative to this federal rate, while the median negotiated rate of $94.00 reflects the contractual agreements between the hospital and payers like Blue Cross Blue Shield, UnitedHealthcare, and Aetna. Although the provided data does not include specific state or county average comparisons for this code, the presence of a Medicare benchmark allows patients to understand that commercial rates often exceed the true cost of care delivery. To ensure you are receiving the best possible rate, we recommend contacting the hospital directly to inquire about "