Physical therapy (therapeutic exercise)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $77
- Cash Discount Price: $77
- vs. Medicare Baseline: 2.65x 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 265% of the Medicare baseline (a markup of 165%). 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 |
|---|---|---|
| Humana | $44 | 151% |
| Tricare | $48 | 165% |
| UnitedHealthcare | $56 - $90 | 193% |
| Medicaid / KanCare | $56 - $90 | 193% |
| Aetna | $56 - $81 | 193% |
| Va Ccn - All Plans | $56 | 193% |
| Ambetter / Centene | $61 | 210% |
| Blue Cross Blue Shield | $78 | 268% |
| Health Partners - All Plans | $86 | 296% |
| Healthy Blue Mcaid - All Plans | $90 | 310% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Trego County Lemke Memorial Hospital in Wakeeney, KS, lists a cash median price of $77.00, which is lower than the facility's negotiated rates of $77.00 and the gross charge of $90.00. While the facility is a Critical Access Hospital with government-local ownership, patients should note that commercial payers like UnitedHealthcare and Medicaid/KanCare have negotiated ranges starting at $56.00 and extending up to $90.00, meaning insurance coverage could result in a lower out-of-pocket cost than paying cash directly. However, for individuals with high-deductible plans, the cash price of $77.00 may be more affordable than the negotiated rates if their insurance has not yet met their deductible, as the commercial allowed amounts can sometimes exceed the cash price.
To ensure you are not overcharged, it is critical to request an itemized billing audit before paying, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a surprise bill for the difference between the provider's full charge and your insurance payment, known as balance billing, you may be protected under the No Surprises Act if you received care at an in-network facility. Additionally, since the facility offers prompt-pay discounts for upfront payment, you should contact the hospital directly to confirm if a self-pay discount is available, which could further reduce the final amount owed compared to the standard cash median.