Physical therapy (therapeutic exercise)
Facility: Saint Luke'S South Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $87
- Cash Discount Price: $158
- vs. Medicare Baseline: 2.99x 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 299% of the Medicare baseline (a markup of 199%). 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 |
|---|---|---|
| Aetna | $18 - $251 | 62% |
| Medicaid / KanCare | $25 - $38 | 86% |
| Transplants-Case Rates [5750] | $25 - $264 | 86% |
| UnitedHealthcare | $35 - $127 | 120% |
| Blue Cross Blue Shield | $37 - $87 | 127% |
| Humana | $51 - $84 | 175% |
| Cigna | $72 - $289 | 248% |
| First Health [5512] | $156 | 537% |
| Commercial-Contracted [8000] | $198 - $214 | 681% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Saint Luke's South Hospital in Overland Park, KS, lists a gross charge of $264.00. While the facility's cash median is $158.00, which is lower than the gross charge, it is important to note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, Cigna's negotiated rate range extends up to $289, and Cigna's average is $180.00, which is higher than the cash price. This illustrates that for patients with high-deductible plans, paying cash upfront can sometimes result in a lower out-of-pocket cost compared to the insurance negotiated rate, provided the patient meets their deductible.
When evaluating the financial impact of this service, the Medicare benchmark serves as the most reliable baseline for understanding true cost. The Medicare amount for this procedure is $29.06, and the facility's cash median of $158.00 represents a markup of 3.0 times the Medicare rate. While commercial negotiated rates vary significantly across payers—ranging from $18 to $289—the data indicates that the facility's cash price is generally lower than the highest negotiated rates found in the market. Patients are encouraged to verify their specific plan's allowed amount before scheduling and to inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill by bypassing insurance processing fees.