Physical therapy (therapeutic exercise)
Facility: St Luke Hospital & Living Center
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $37
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.27x 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 |
|---|---|---|
| UnitedHealthcare | $32 - $43 | 110% |
| Blue Cross Blue Shield | $32 - $43 | 110% |
| Humana | $32 - $43 | 110% |
| Va Ccn | $32 - $43 | 110% |
| Ambetter / Centene | $32 - $43 | 110% |
| Kansas Department Of Health And Environment | $32 - $43 | 110% |
| Bluestem Pace | $32 - $43 | 110% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), St Luke Hospital & Living Center in Marion, KS, has a gross charge of $73.00. This facility is a Critical Access Hospital owned by a Government Hospital District. While the facility does not currently list a specific cash median or negotiated median in this dataset, the Medicare benchmark for this service is $29.06. The facility's gross charge is 1.3 times the Medicare rate, which falls within the typical range where commercial rates can be 200% to 300% of Medicare. Patients should be aware that while cash payments can sometimes be cheaper than insurance negotiated rates—particularly for those with high-deductible plans where the insurer's allowed amount might exceed the cash price—it is essential to verify the specific self-pay or prompt-pay discounts directly with the hospital before scheduling, as these rates are not always automatically applied.
Insurance data indicates that seven payers, including UnitedHealthcare, Blue Cross Blue Shield, and Humana, have negotiated rates ranging from $32.00 to $43.00 for this service, with a median negotiated rate of $37.00. These figures represent the contractual ceiling rates that in-network members are protected from, preventing balance billing for covered services at this in-network facility. However, patients should remain vigilant regarding balance billing if they receive care from out-of-network providers or for unexpected ancillary services, as the No Surprises Act prohibits balance billing for emergency and non-emergency services at in-network facilities. If a patient receives a surprise bill, they should dispute it in writing with their insurer rather than paying immediately, and they