CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: The McDowell Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97110
  • Insurance Median: $45
  • Cash Discount Price: $120
  • vs. Medicare Baseline: 1.55x Medicare
The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at The McDowell Hospital is $45. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $120. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.55x the Medicare baseline. Located in 430 Rankin Drive P O Box 730, Marion, NC.
Cash / Self-Pay
$120

Average discount available for prompt cash payment at this facility.

Insurance Median
$45

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate
$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)
Cash / Self-Pay: $120 (413%)
Insurance Median: $45 (155%)
Cash: $120 (413% of Medicare)
Ins. Median: $45 (155% of 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Input your details and click calculate to compare out-of-pocket costs.

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 $13 - $18 45%
Amerihealth $14 - $19 48%
Partners Health Management $14 - $19 48%
United $14 - $71 48%
Vaya Health $14 - $19 48%
Wellcare $14 - $29 48%
Apex Health $20 - $28 69%
Aetna $25 - $100 86%
Alignment Health $25 - $28 86%
Devoted Health $25 - $28 86%
Humana $25 - $29 86%
Provider Partners Health Plan $26 - $30 89%
Cigna $27 - $74 93%
Healthteam Advantage $27 - $31 93%
Troy Healthcare $27 - $30 93%
Amerihealth Caritas $28 - $65 96%
Longevity Health Plan $30 - $34 103%
Caresource $44 - $61 151%
Medcost $49 - $117 169%
Magellan $60 - $83 206%
Magellan Behavioral Health $60 - $83 206%
Multiplan $80 - $111 275%
Avalon Administrative Services $85 - $117 292%
Prime Health $88 - $124 303%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 430 Rankin Drive P O Box 730, Marion, NC 28752
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals