Physical therapy (therapeutic exercise)
Facility: Lmh
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $28
- Cash Discount Price: $55
- vs. Medicare Baseline: 0.96x 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 |
|---|---|---|
| Allwell | $25 - $28 | 86% |
| Blue Cross Blue Shield | $25 - $142 | 86% |
| UnitedHealthcare | $25 - $185 | 86% |
| Aetna | $27 - $182 | 93% |
| Humana | $28 | 96% |
| Haskell Indian Health Services | $28 | 96% |
| Medicare (plans) | $28 | 96% |
| Cigna | $28 - $147 | 96% |
| Ambetter / Centene | $36 - $43 | 124% |
| Non Contracted | $176 | 606% |
| First Health | $204 | 702% |
Consumer Guidance & Cost Commentary
For this physical therapy session, the facility's cash price of $55.00 is significantly lower than the negotiated rates charged to most insurance plans, which range from $25 to $185 depending on the carrier. While the facility's cash rate is higher than the state average of $28.00, it remains well below the gross charges listed on chargemasters, which often inflate costs to make insurance discounts appear larger. If you have a high-deductible plan or have not yet met your deductible, paying the cash price of $55.00 upfront may be more cost-effective than relying on insurance, which could result in a negotiated rate exceeding $100 after your deductible is applied. We recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed if you settle the bill immediately.
The facility's billing practices align with federal standards, as the Medicare benchmark rate for this service is $29.06, and the facility's negotiated average of $28.00 is slightly below this baseline, indicating fair pricing relative to the government's cost-based standard. However, patients should be aware that commercial insurance contracts often include administrative overhead that inflates the baseline price by 20% to 40%, meaning the negotiated rate does not always reflect the true cost of care. To ensure you are not overcharged, we advise requesting an itemized bill that breaks down every CPT code and unit cost, as summary bills can obscure errors or unbundled charges. If you receive a large post-service bill, dispute it in writing with the billing supervisor rather than accepting verbal assurances, and verify that no balance billing