Physical therapy (therapeutic exercise)
Facility: Medstar Harbor Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $155
- Cash Discount Price: $152
- vs. Medicare Baseline: 5.33x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 533% of the Medicare baseline (a markup of 433%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Aetna | $95 - $172 | 327% |
| Amerigroup | $95 - $172 | 327% |
| Amerihealth Caritas District Of Columbia | $95 - $172 | 327% |
| Carefirst Advantage Inc | $95 - $172 | 327% |
| Carefirst Blue Choice Inc | $95 - $172 | 327% |
| Cigna | $95 - $172 | 327% |
| First Health | $95 - $172 | 327% |
| Hscsn | $95 - $172 | 327% |
| Humana | $95 - $172 | 327% |
| Kaiser Permanente | $95 - $172 | 327% |
| Magellan Behavioral Health Inc | $95 - $172 | 327% |
| Mamsi | $95 - $172 | 327% |
| Medstar Family Choice | $95 - $172 | 327% |
| Medstar Family Choice Inc | $95 - $172 | 327% |
| Ncppo Healthlink Ppo | $95 - $172 | 327% |
| Pfc | $95 - $172 | 327% |
| Private Healthcare Systems (Phcs) | $95 - $172 | 327% |
| Tricare | $95 - $172 | 327% |
| United Behavioral Health Inc | $95 - $172 | 327% |
| UnitedHealthcare | $95 - $172 | 327% |
Consumer Guidance & Cost Commentary
For a self-pay patient, the most immediate fact to know is that the cash price for this physical therapy service is $152.00, which is significantly lower than the facility's gross charge of $155.00. While commercial insurance plans typically negotiate rates up to $172.00, the cash rate remains the lowest option available on record. Patients with high-deductible plans should consider paying the $152.00 cash price directly, as this avoids out-of-pocket costs that might exceed the negotiated rate if their deductible has not yet been met. To ensure they receive the best possible price, patients are advised to verify with the hospital whether additional "self-pay" or "prompt-pay" discounts are available before scheduling the service.
The broader pricing context shows that the cash rate of $152.00 is substantially lower than the facility's negotiated rate of $155.00. This service is also priced well below the Medicare benchmark of $29.06 when adjusted for the specific vintage and geographic factors, though the data indicates a variance factor of 5.3 relative to Medicare. It is important to note that while commercial payers may offer rates as high as $172.00, these figures often include administrative overheads and do not represent the true cost basis. Consumers should be aware that commercial rates can sometimes be higher than cash prices due to the complexity of insurance billing cycles, making direct payment a potentially more economical choice for eligible individuals.