Physical therapy (therapeutic exercise)
Facility: Amberwell Atchison Association
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $62
- Cash Discount Price: $133
- vs. Medicare Baseline: 2.13x 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 213% of the Medicare baseline (a markup of 113%). 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 | $19 - $370 | 65% |
| Humana | $19 - $93 | 65% |
| Triwest - All Plans | $19 - $68 | 65% |
| Va Ccn - All Plans | $19 - $68 | 65% |
| Superior Select Mcr Adv - All Plans | $19 - $68 | 65% |
| Ambetter / Centene | $30 - $105 | 103% |
| Cigna | $32 - $113 | 110% |
| Aetna | $32 - $113 | 110% |
| Oscar - All Plans | $44 - $154 | 151% |
| Centrus Health Direct - All Plans | $44 - $154 | 151% |
| Multiplan - All Plans | $46 - $161 | 158% |
| Wppa Providrs Care - All Plans | $53 - $185 | 182% |
| Blue Cross Blue Shield | $54 - $57 | 186% |
Consumer Guidance & Cost Commentary
For this physical therapy service at Amberwell Atchison Association, the cash price of $133 is notably higher than the Medicare benchmark rate of $29.06, which serves as the federal baseline for the true cost of care. While the facility lists a gross charge of $133, the median negotiated rate paid by insurers is $62, and the actual median paid amount is $68. This pricing structure highlights that commercial insurance contracts often result in higher final costs for patients compared to cash payment, particularly when the negotiated rate exceeds the cash price.
Patients should be aware that while the facility is a voluntary non-profit Critical Access Hospital in Atchison, KS, there is no state or county average provided for comparison in this dataset. With 13 payers participating, the lowest negotiated rate found is $19 (UnitedHealthcare), while the highest is $185 (Wppa Providers Care). Because the cash price of $133 is lower than many of these negotiated rates, patients with high-deductible plans may save money by paying out-of-pocket and then asking the hospital for a "self-pay" or "prompt-pay" discount before the insurance claim is processed. To avoid unexpected balance billing or administrative fees, it is essential to request an itemized audit of the bill and explicitly confirm that no insurance submission will occur if paying cash.