Physical therapy (therapeutic exercise)
Facility: Osborne County Memorial Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $80
- Cash Discount Price: $75
- vs. Medicare Baseline: 2.75x 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 275% of the Medicare baseline (a markup of 175%). 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 |
|---|---|---|
| UnitedHealthcare | $66 - $67 | 227% |
| Health Partners Of Kansas | $75 - $76 | 258% |
| Wppa | $83 - $84 | 286% |
| Blue Cross Blue Shield | $85 - $86 | 292% |
Consumer Guidance & Cost Commentary
For this physical therapy service at Osborne County Memorial Hospital, the cash price of $75.00 is notably lower than the facility's negotiated rates with major payers, which range from $66 to $86 depending on the insurance plan. While the cash rate is also lower than the gross chargemaster of $88.00, it is important to note that commercial negotiated rates often exceed cash prices due to administrative costs and contract structures. Patients with high-deductible plans may find the cash price more advantageous if their insurance negotiated rate is higher than $75.00, as paying out-of-pocket could result in immediate savings compared to the amount the insurer would allow. Additionally, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by 20% to 50% if settled upfront.
This facility's pricing is evaluated against federal benchmarks to ensure transparency. The Medicare benchmark for this service is $29.06, and the cash price of $75.00 represents a markup of 2.8 times the Medicare rate. While commercial rates are typically higher than Medicare due to the inclusion of practice expenses and malpractice insurance, the cash price here remains competitive relative to the national average for this procedure. Because over 80% of hospital bills contain errors, patients should request a detailed, itemized statement rather than accepting a summary bill, which may hide unbundled charges or services not rendered. If a balance bill arises from an out-of-network provider, patients can dispute the amount under the No Surprises Act, and any discrepancies should be addressed in writing to protect their financial interests.