CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: City of Hope National Medical Center

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $123
Cash Discount Price: $141
vs. Medicare Baseline: 4.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at City of Hope National Medical Center is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $141. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.23x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$141

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $141 (485%)

Insurance Median: $123 (423%)

Cash: $141 (485% of Medicare)

Ins. Median: $123 (423% 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 423% of the Medicare baseline (a markup of 323%). 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
Health Net	$9 - $179	31%
Heritage Provider Network	$11 - $107	38%
Cal Optima	$12 - $32	41%
Inland Empire	$19 - $122	65%
Prime Healthcare Keenan	$56 - $146	193%
Blue Cross Blue Shield	$65 - $305	224%
UnitedHealthcare	$73 - $305	251%
Blue Shield	$77 - $305	265%
Blue Shield Promise	$91 - $107	313%
Cencal	$104 - $122	358%
La Care Health	$104 - $122	358%
Kaiser	$117 - $137	403%
Aetna	$130 - $152	447%
Gold Coast	$130 - $152	447%
Molina	$130 - $198	447%
Cigna	$140 - $164	482%
Facey	$143 - $168	492%
Healthcare Partners	$151 - $177	520%
St. Joseph Heritage	$156 - $183	537%
Primecare Medical Network	$169 - $198	582%
First Health	$200 - $235	688%
Phcs Multiplan	$234 - $274	805%
Blue Shield Covca	$238	819%

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 $141.
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 City of Hope National Medical Center 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.