Physical therapy (therapeutic exercise)
Facility: Bob Wilson Memorial Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $98
- Cash Discount Price: $48
- vs. Medicare Baseline: 3.37x 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 337% of the Medicare baseline (a markup of 237%). 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 |
|---|---|---|
| Kansas Health | $38 | 131% |
| Aetna | $38 - $96 | 131% |
| Humana | $38 | 131% |
| Medicare (plans) | $38 | 131% |
| UnitedHealthcare | $38 - $100 | 131% |
| Centura Employee Plan | $72 | 248% |
| Blue Cross Blue Shield | $76 | 262% |
| Multiplan | $108 - $112 | 372% |
| Health Partners Of Kansas | $113 | 389% |
| Wppa | $114 | 392% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Bob Wilson Memorial Hospital in Ulysses, KS, lists a gross charge of $120.00. While the facility's cash median rate is $48.00, commercial insurance negotiated rates vary significantly by payer, ranging from a low of $38.00 with Kansas Health and Aetna to a high of $114.00 with Wppa and Health Partners Of Kansas. It is important to note that for patients with high-deductible plans, paying the cash price of $48.00 upfront may result in lower out-of-pocket costs compared to the insurance negotiated rates, which 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 bill if paid in full within a short window.
When evaluating the cost relative to the national standard, the facility's cash rate of $48.00 is 3.4 times the Medicare benchmark amount of $29.06 for this service. Although the facility is a Critical Access Hospital owned by a voluntary non-profit church, the negotiated rates across its ten payer plans span a wide range, with UnitedHealthcare showing a spread between $38.00 and $100.00. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but it is crucial to verify network status and deductible status before scheduling to avoid unexpected charges. Finally, if a detailed bill