CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Boston Children's Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $136
Cash Discount Price: $191
vs. Medicare Baseline: 4.68x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Boston Children's Hospital is $136. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $191. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.68x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$191

Average discount available for prompt cash payment at this facility.

Insurance Median

$136

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: $191 (657%)

Insurance Median: $136 (468%)

Cash: $191 (657% of Medicare)

Ins. Median: $136 (468% 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 468% of the Medicare baseline (a markup of 368%). 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
Cdphp	$94 - $162	323%
Harvard Pilgrim	$97 - $129	334%
Unicare	$107	368%
Blue Cross Blue Shield	$108 - $126	372%
United	$114 - $160	392%
Aetna	$115 - $160	396%
Mgb/Allways	$116 - $141	399%
Tufts Public Plan	$117 - $118	403%
United Ri Nj Ny	$120	413%
Ambetter / Centene	$121	416%
Carelon Strategies/Bhs	$124	427%
UnitedHealthcare	$124 - $162	427%
Carelon/Beacon	$143	492%
Fallon	$146 - $147	502%
Health New England	$154	530%
Cigna	$162 - $172	557%
Ets/Lifetrac	$162	557%
Interlink Transplant	$162	557%
Community Health Options	$172	592%
Humana	$172	592%
Coventry/Hcvm/First Health	$176	606%
Multiplan/Phcs	$176 - $181	606%

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 $191.
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 Boston Children's 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.