CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: St Louis Childrens Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $158
Cash Discount Price: $133
vs. Medicare Baseline: 5.44x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at St Louis Childrens Hospital is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.44x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$133

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $133 (458%)

Insurance Median: $158 (544%)

Cash: $133 (458% of Medicare)

Ins. Median: $158 (544% of 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 544% of the Medicare baseline (a markup of 444%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$28 - $175	96%
Blue Cross Blue Shield	$28 - $188	96%
Essence Healthcare [221]	$28	96%
Humana	$28 - $165	96%
UnitedHealthcare	$28 - $164	96%
Cox Health [757]	$30	103%
Medica [662]	$30	103%
Healthlink [225]	$107 - $167	368%
Cigna	$109 - $120	375%
Apwu Health Plan [216]	$120	413%
Consociate [478]	$120	413%
Nalc Health Benefit Plan [242]	$120	413%
Priority Health [648]	$120	413%
Sarah Bush Lincoln [636]	$120	413%
Cox Health Systems Insurance Company [220]	$122 - $164	420%
Allied Benefits [498]	$128 - $175	440%
Hope Trust [806]	$128	440%
Med-Pay [480]	$144 - $166	496%
Unicare [568]	$144 - $167	496%
Health Alliance [224]	$155	533%
Healthscope Benefits [258]	$158 - $177	544%
First Health Commercial [734]	$164	564%
Beechstreet [551]	$166	571%
Detego Health [868]	$166	571%
Health Systems Inc [620]	$166	571%
Healthcare Sol Mercy [609]	$166	571%
Multiplan Commercial [737]	$166	571%
Multiplan [240]	$166	571%
Phcs [244]	$166 - $177	571%
Preferred Health Professionals [561]	$167	575%
Coresource [497]	$175	602%
Fmh Benefit Service Inc [222]	$175	602%
Mail Handlers [495]	$175	602%
Medica [661]	$177	609%
Hfn [563]	$188	647%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $133.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97110.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Louis Childrens Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97110.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.