CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Unity Physicians Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $11,325
Cash Discount Price: Unavailable
vs. Medicare Baseline: 389.71x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Unity Physicians Hospital is $11,325. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 389.71x the Medicare baseline. Located in 4455 Edison Lakes Pkwy, Mishawaka, IN.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$11,325

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%)

Insurance Median: $11,325 (38971%)

Ins. Median: $11,325 (38971% 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 38971% of the Medicare baseline (a markup of 38871%). 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
Nalc	$41 - $23,749	141%
Sagamore Health Network	$41 - $23,749	141%
Multiplan	$44	151%
Multiplan Wc	$55	189%
Aarp Supplemental	$11,325	38971%
Aetna	$11,325	38971%
Blue Cross Blue Shield	$11,325 - $17,574	38971%
Cigna	$11,325	38971%
Department Of Va	$11,325	38971%
Medicare (plans)	$11,325	38971%
Mhs Healthy Indiana Plan	$11,325	38971%
Railroad Retirement	$11,325	38971%
UnitedHealthcare	$11,325 - $23,749	38971%
Three Rivers Provider Network	$13,590	46765%
Encore	$20,386	70151%
Humana	$21,000	72264%
Provider Network Of America	$22,651	77946%
All Savers	$23,749	81724%
Medica	$23,749	81724%
Medica Ifb	$23,749	81724%
Oxford	$23,749	81724%

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 $X.
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 Unity Physicians 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.