Physical therapy (therapeutic exercise)
Facility: Morris County Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $80
- Cash Discount Price: $67
- 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 |
|---|---|---|
| Blue Cross Blue Shield | $43 - $57 | 148% |
| UnitedHealthcare | $43 - $112 | 148% |
| Choice Care Mcr Adv-All Plans | $43 - $44 | 148% |
| Coventry Mcr | $43 - $44 | 148% |
| Va Ccn-All Plans | $43 - $44 | 148% |
| Cigna | $80 - $81 | 275% |
| Coventry Comm-All Other Plans | $99 - $101 | 341% |
| Aetna | $99 - $100 | 341% |
| Multiplan-All Plans | $99 - $101 | 341% |
| Providrs Care (Wppa)(Nexus)-All Plans | $165 - $168 | 568% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Morris County Hospital in Council Grove, KS, lists a gross charge of $111.00. This amount is significantly higher than the Medicare benchmark of $29.06, which serves as the federally established baseline for the true cost of this service. While the facility's cash median price is $67.00 and the median negotiated rate across payers is $80.00, both figures remain well above the Medicare rate. It is important to note that for patients with high-deductible plans, paying the cash price of $67.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price due to administrative overhead and contract structures. Additionally, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed.
The facility is a Critical Access Hospital owned by the local government, and while the Medicare benchmarking principle suggests that fair pricing typically falls between 120% and 150% of the Medicare rate, the gross charge here represents a substantial markup. Commercial payers negotiate rates that vary widely; for instance, UnitedHealthcare plans range from $43 to $112, whereas Choice Care and Coventry Mcr plans range from $43 to $44. These variations highlight that being in-network does not guarantee the lowest possible rate, as different insurers have distinct contract ceilings. To ensure you are not overcharged, it is advisable to request a detailed, itemized billing audit before finalizing payment, as over 80%