CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Northwestern Lake Forest Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $115
Cash Discount Price: $165
vs. Medicare Baseline: 3.96x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Northwestern Lake Forest Hospital is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.96x the Medicare baseline. Located in 1000 N Westmoreland Road, Lake Forest, IL.

Cash / Self-Pay

$165

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $165 (568%)

Insurance Median: $115 (396%)

Cash: $165 (568% of Medicare)

Ins. Median: $115 (396% 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 396% of the Medicare baseline (a markup of 296%). 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	$39 - $107	134%
Blue Cross Blue Shield	$50 - $236	172%
Cigna	$50 - $115	172%
Healthlink [125]	$118	406%
Health'S Finest Network [126]	$151 - $212	520%
The Alliance [1703]	$152	523%
Beechstreet [176]	$189	650%
Multiplan/Phcs [142]	$189 - $236	650%
First Health Plan [6034]	$194	668%
UnitedHealthcare	$236	812%

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 $165.
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 Northwestern Lake Forest 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.