Physical therapy (therapeutic exercise)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $60
- Cash Discount Price: $78
- vs. Medicare Baseline: 2.06x 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 206% of the Medicare baseline (a markup of 106%). 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 | $21 - $27 | 72% |
| First Health Contracted [320128] | $21 | 72% |
| Medicaid / KanCare | $22 - $28 | 76% |
| Blue Cross Blue Shield | $25 - $37 | 86% |
| UnitedHealthcare | $25 - $111 | 86% |
| Humana | $26 - $27 | 89% |
| Pace Of The Ozarks Contracted [320518] | $27 | 93% |
| Medical Associates Health Contracted [320444] | $27 | 93% |
| Dept Of Veteran Affairs Contracted [320106] | $27 | 93% |
| Centivo Contracted [320505] | $27 | 93% |
| Mercy Hospice Okc [20252] | $27 | 93% |
| Elara Caring Aspire Hospice [20433] | $27 | 93% |
| Kindful Hospice Contracted [320434] | $27 | 93% |
| Qual Choice Contracted [320325] | $27 | 93% |
| Medicare (plans) | $27 | 93% |
| Kindful Hospice [20434] | $27 | 93% |
| Cross Timbers Hospice [20098] | $27 | 93% |
| Cigna | $27 - $92 | 93% |
| Globalhealth Contracted [320145] | $27 | 93% |
| Mercy Mgd Behavioral Health Contracted [320259] | $27 | 93% |
| Cherokee Nation Health Serv Contracted [320066] | $27 | 93% |
| Halo Hcr Inc Hospice Contracted [320432] | $27 | 93% |
| Halo Hcr Inc Hospice [20432] | $27 | 93% |
| Tricare | $27 | 93% |
| Provider Partners Health Plans Contracted [320450] | $29 | 100% |
| Medica Contracted [320239] | $44 | 151% |
| Providrs Care Network Contracted [320484] | $52 | 179% |
| Point C Contracted [320238] | $60 - $90 | 206% |
| Mercy Benefit Admin Contracted [320251] | $72 - $84 | 248% |
| Show-Me Health Administrators Contracted [320483] | $72 | 248% |
| Imagine 360 Contracted [320494] | $84 | 289% |
| Edison Health Solutions Contracted [320502] | $84 | 289% |
| American Healthcare Alliance Contracted [320020] | $84 | 289% |
| Reflect Health Contracted [320492] | $84 | 289% |
| Auxiant Contracted [320462] | $84 - $90 | 289% |
| Ebms Contracted [320493] | $84 | 289% |
| Aither Health Contracted [320449] | $84 | 289% |
| Yuzu Health Contracted [320521] | $84 | 289% |
| United Medical Resources Contracted [320454] | $90 - $102 | 310% |
| Insurance System Inc Contracted [320465] | $90 | 310% |
| Benefit Management Contracted [320052] | $90 | 310% |
| Federal Medical Center Contracted [320127] | $90 | 310% |
| Preferred Health Plan Contracted [320522] | $90 | 310% |
| Healthlink Contracted [320179] | $90 | 310% |
| Healthscope Contracted [320182] | $90 | 310% |
| Health Systems Inc Contracted [320174] | $90 | 310% |
| Compcare Of The Ozarks Contracted [320437] | $95 | 327% |
| Workers Comp [20426] | $96 | 330% |
| Private Health Care Systems Contracted [320320] | $111 | 382% |
| Multiplan Contracted [320270] | $114 | 392% |
| Multiplan [20270] | $114 | 392% |
Consumer Guidance & Cost Commentary
For the CPT code 97110 (Physical therapy), the gross charge at Mercy Specialty Hospital Southeast Kansas is $120.00. While the facility offers a cash median price of $78.00, which is lower than the state average of $114.00, patients with high-deductible plans may find that paying cash upfront is more cost-effective than relying on insurance. Many commercial payers, including UnitedHealthcare and Point C, have negotiated rates that range from $25 to $90, which can exceed the cash price. It is important to note that commercial negotiated rates often include administrative overhead and are typically 200% to 300% of the Medicare benchmark of $29.06, whereas fair pricing is generally defined as 120% to 150% of this baseline.
Patients should proactively request a "self-pay" or "prompt-pay" discount before scheduling services to avoid balance billing or unexpected costs. Although the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, it is crucial to verify that all ancillary services are covered under the same contract. If a summary bill is received, consumers should demand a full itemized CPT-coded statement to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors. By comparing the facility's cash rate directly to the Medicare benchmark and asking for prompt-pay incentives, patients can ensure they are paying a transparent and fair amount for their care.