CMS Price Transparency Data
Physical therapy (therapeutic exercise)
Facility: Saint Joseph Regional Medical Center
Billing Code: 97110 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97110
- Insurance Median: $53
- Cash Discount Price: $76
- vs. Medicare Baseline: 1.82x Medicare
The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Saint Joseph Regional Medical Center is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $76. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.82x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$76
Average discount available for prompt cash payment at this facility.
Insurance Median
$53
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: $76 (262%)
Insurance Median: $53 (182%)
Cash: $76 (262% of Medicare)
Ins. Median: $53 (182% 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 |
|---|---|---|
| Hospice Of Marshall County | $14 - $47 | 48% |
| Hospice Of St Joseph County | $14 - $47 | 48% |
| Plain Church Group | $14 - $49 | 48% |
| Aetna | $16 - $118 | 55% |
| Blue Cross Blue Shield | $16 - $186 | 55% |
| Medicaid / KanCare | $16 - $186 | 55% |
| UnitedHealthcare | $16 - $186 | 55% |
| Medicare (plans) | $28 - $29 | 96% |
| Meridian Complete | $28 | 96% |
| Pace-Trinity Health | $28 | 96% |
| County Coroner | $29 | 100% |
| Notre Dame Athletic Association | $29 - $100 | 100% |
| Wc Notre Dame | $29 - $100 | 100% |
| Luminare Health (Detroit) | $30 - $109 | 103% |
| Encore Health | $31 - $113 | 107% |
| Provider Partners Health Plan Of Indiana | $31 | 107% |
| Ameriben | $32 - $109 | 110% |
| Auxiant | $33 - $150 | 114% |
| Indiana Criminal Justice Inst | $33 - $113 | 114% |
| Key Benefit Administrator | $33 - $113 | 114% |
| Western & Southern Financial Group | $33 - $113 | 114% |
| Allied Benefit Systems | $34 - $118 | 117% |
| Asr Health Benefits | $34 - $118 | 117% |
| Christian Brother Services | $34 - $118 | 117% |
| Cigna | $34 - $116 | 117% |
| Employee Benefit Management | $34 - $118 | 117% |
| Geha | $34 - $115 | 117% |
| Group Administrators | $34 - $116 | 117% |
| Health Partners | $34 - $116 | 117% |
| Healthscope | $34 - $115 | 117% |
| Medical Mutual | $34 - $118 | 117% |
| Meritain | $34 - $118 | 117% |
| Mvp | $34 - $116 | 117% |
| Prairie States | $34 - $116 | 117% |
| Preferred One | $34 - $118 | 117% |
| Priority Health | $34 - $116 | 117% |
| Professional Benefit Administrators | $34 - $116 | 117% |
| Rural Carrier Health Benefit Plan | $34 - $118 | 117% |
| Sagamore Health Network | $34 - $134 | 117% |
| Sisco Benefits | $34 - $116 | 117% |
| Student Insurance Cma | $34 - $115 | 117% |
| Unified Group Services | $34 - $116 | 117% |
| Webtpa | $34 - $118 | 117% |
| Goshen Preferred Network | $41 - $156 | 141% |
| Christian Brothers Holy Cross | $42 - $145 | 145% |
| Physicians Health Plan Northern Indiana Health Insurance | $42 - $85 | 145% |
| Signature Care | $42 - $145 | 145% |
| St Joseph County Hlth Dpt | $42 | 145% |
| Caresource | $43 | 148% |
| Siho Insurance Services | $45 | 155% |
| Bankers Life Casualty | $53 - $181 | 182% |
| Bureau Of Disability | $53 - $181 | 182% |
| Wc Align Network | $53 - $181 | 182% |
| Blue Benefit Administrators Of Massachusetts | $56 | 193% |
| Blue Care Network | $56 | 193% |
| Blue Distinction Transplant | $56 | 193% |
| Blue Shield - Ca | $56 | 193% |
| Blue Shield - Id (Regence) | $56 | 193% |
| Blue Shield - Ny Highmark Northeastern | $56 | 193% |
| Blue Shield - Ny Highmark Western | $56 | 193% |
| Blue Shield - Pa (Highmark) | $56 | 193% |
| Blue Shield - Wa (Regence) | $56 | 193% |
| Custom Design Benefits | $60 | 206% |
| Managed Health Services - Indiana | $186 | 640% |
| Mdwise | $186 | 640% |