Physical therapy (therapeutic exercise)
Facility: Stormont Vail Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $54
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.86x 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.
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 |
|---|---|---|
| Blue Cross Blue Shield | $29 - $76 | 100% |
| Ambetter / Centene | $29 | 100% |
| UnitedHealthcare | $29 | 100% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Stormont Vail Hospital in Topeka, KS, has a gross charge of $197.00. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range from $29.00 to $76.00, the median amount paid by insurers is significantly higher at $12,614.00, which is 1.9 times the Medicare benchmark of $29.06. This substantial gap between the commercial negotiated rate and the Medicare benchmark highlights that commercial insurance contracts often include administrative overheads that inflate the baseline price. For patients with high-deductible plans, the cash price may offer a more affordable option if the insurance negotiated rate exceeds the cash price, though the data indicates no specific cash rate was reported for this service.
To minimize costs, patients should proactively contact the hospital to inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full upfront. It is critical to request a full itemized billing audit before agreeing to any payment plan, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should verify their specific plan details and deductible status before scheduling care to avoid unexpected out-of-pocket expenses.