Physical therapy (therapeutic exercise)

For the CPT code 97110, representing physical therapy (therapeutic exercise), the University of Kansas Hospital lists a gross charge of $178.00. While the facility's cash median rate is $36.00, commercial insurance negotiated rates vary significantly, ranging from a low of $24 to a high of $338 across 59 different payers. Notably, the lowest negotiated rates found in this dataset are $24 and $27, which are substantially lower than the facility's cash price. This suggests that for patients with high-deductible plans or those who have met their deductible, paying the cash price of $36.00 may be more cost-effective than relying on insurance, which often results in higher allowed amounts due to administrative overhead and contract structures.

When evaluating the facility's pricing against federal benchmarks, the Medicare amount for this service is $29.06. The facility's cash rate of $36.00 represents a markup of approximately 24% over the Medicare benchmark, which is generally considered a fair pricing range compared to commercial rates that can average 200% to 300% of the Medicare amount. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is crucial to verify the specific allowed amount before scheduling. Additionally, since the facility is a government-owned hospital district, patients should proactively inquire about self-pay or prompt-pay discounts, which can further reduce the final bill by bypassing standard insurance billing cycles.