Physical therapy (therapeutic exercise)
Facility: Clay County Medical Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $75
- Cash Discount Price: $79
- 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 |
|---|---|---|
| Aetna | $73 | 251% |
| Wppa/Providrs Care- All Plans | $73 | 251% |
| UnitedHealthcare | $75 | 258% |
| Health Partners - All Plans | $75 | 258% |
| Multiplan- All Plans | $75 | 258% |
Consumer Guidance & Cost Commentary
For CPT code 97110, Physical therapy (therapeutic exercise), Clay County Medical Center in Clay Center, KS, lists a cash median price of $79.00, which matches the gross chargemaster rate. This cash rate is significantly higher than the state average for this service, though specific county averages were not provided in the data. While commercial payers like Aetna, UnitedHealthcare, and others have negotiated rates averaging $73.00 to $75.00, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $79.00. It is important to note that commercial negotiated rates often include administrative overhead and can be higher than cash prices due to multi-layered billing structures, so patients should verify their specific plan's allowed amount before scheduling.
To avoid unexpected costs, patients should proactively ask the facility about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if a patient receives care from an out-of-network provider or encounters services billed at the full chargemaster rate, they may be subject to balance billing, where the provider charges the difference between the negotiated rate and the actual cost. Under the No Surprises Act, balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities, so patients should dispute any surprise bills immediately rather than accepting them. Finally, because over 80% of hospital bills contain errors, patients should request a detailed, itemized bill to review specific CPT codes and ensure no charges were unbundled or for