CMS Price Transparency Data
Physical therapy (therapeutic exercise)
Facility: Mercy Health Lakeshore Campus
Billing Code: 97110 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97110
- Insurance Median: $135
- Cash Discount Price: $102
- vs. Medicare Baseline: 4.65x Medicare
The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Mercy Health Lakeshore Campus is $135. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $102. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.65x the Medicare baseline. Located in 72 South State Street, Shelby, MI.
Cash / Self-Pay
$102
Average discount available for prompt cash payment at this facility.
Insurance Median
$135
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: $102 (351%)
Insurance Median: $135 (465%)
Cash: $102 (351% of Medicare)
Ins. Median: $135 (465% 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 465% of the Medicare baseline (a markup of 365%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $21 - $134 | 72% |
| Medicaid / KanCare | $21 | 72% |
| Access Health | $27 | 93% |
| Blue Care Network Advantage | $38 | 131% |
| Medicare (plans) | $38 | 131% |
| Aetna | $39 - $125 | 134% |
| Align Senior Care | $39 | 134% |
| Correctional Recovery | $39 | 134% |
| Wellpath | $43 | 148% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $44 | 151% |
| U Of M Health Plan | $44 - $141 | 151% |
| Oscar | $48 | 165% |
| Vitalcore | $52 | 179% |
| UnitedHealthcare | $55 - $141 | 189% |
| Molina Marketplace | $65 | 224% |
| Hospice Of Michigan | $86 | 296% |
| Nomi Health | $88 | 303% |
| Hap | $118 - $144 | 406% |
| Wc Accident Fund | $124 | 427% |
| Wc Advantage | $124 | 427% |
| Wc Aig | $124 | 427% |
| Wc Allied | $124 | 427% |
| Wc Amerisure | $124 | 427% |
| Wc Amtrust | $124 | 427% |
| Wc Asu Risk Mgt | $124 | 427% |
| Wc Berkley Admin | $124 | 427% |
| Wc Broadspire | $124 | 427% |
| Wc Bunch & Associates | $124 | 427% |
| Wc Ccmsi | $124 | 427% |
| Wc Emc Insurance Company | $124 | 427% |
| Wc Esis | $124 | 427% |
| Wc Fcci | $124 | 427% |
| Wc Federated | $124 | 427% |
| Wc Gallagher Bassett | $124 | 427% |
| Wc Genex Care For Ohio | $124 | 427% |
| Wc Guard Insurance Company | $124 | 427% |
| Wc Hartford | $124 | 427% |
| Wc Liberty Mutual | $124 | 427% |
| Wc Meijers | $124 | 427% |
| Wc Michigan | $124 | 427% |
| Wc Mitchell Frankenmuth | $124 | 427% |
| Wc Pma | $124 | 427% |
| Wc Sedgwick | $124 | 427% |
| Wc Sentry | $124 | 427% |
| Wc Travelers | $124 | 427% |
| Wc Tristar | $124 | 427% |
| Wc Walmart | $124 | 427% |
| Wc Zurich | $124 | 427% |
| Geha | $125 - $141 | 430% |
| Meritain | $125 | 430% |
| Asr Health Benefits | $131 | 451% |
| Bcn Domestic | $134 | 461% |
| Blue Benefit Administrators Of Massachusetts | $134 | 461% |
| Blue Care Network | $134 | 461% |
| Blue Distinction Transplant | $134 | 461% |
| Blue Shield - Ca | $134 | 461% |
| Blue Shield - Id (Regence) | $134 | 461% |
| Blue Shield - Ny Highmark Northeastern | $134 | 461% |
| Blue Shield - Ny Highmark Western | $134 | 461% |
| Blue Shield - Pa (Highmark) | $134 | 461% |
| Blue Shield - Wa (Regence) | $134 | 461% |
| Health Choices | $134 - $141 | 461% |
| Kaiser Domestic | $134 | 461% |
| 1199 National Benefit Fund | $135 | 465% |
| Allied National Global Care | $135 | 465% |
| Asrm - Reliance Standard Life Insurance | $135 | 465% |
| Christian Care Ministry | $135 | 465% |
| Dean Health | $135 | 465% |
| Fallon Health | $135 | 465% |
| Family Life Insurance Company | $135 | 465% |
| Ghc Scw | $135 | 465% |
| Group Pension Administrators | $135 | 465% |
| International Benefit Administrators | $135 | 465% |
| Lifetime Benefit Solutions | $135 | 465% |
| Manhattan Life | $135 | 465% |
| Medi Share | $135 | 465% |
| Multiplan | $135 | 465% |
| Mvp | $135 | 465% |
| Pai | $135 | 465% |
| Pan-American Life | $135 | 465% |
| Paramount Hmo | $135 | 465% |
| Phcs | $135 | 465% |
| Trinity Health Share | $135 | 465% |
| Cigna | $136 | 468% |
| Caresource | $140 | 482% |
| Acclaim | $141 | 485% |
| Administrative Concepts | $141 | 485% |
| Allegeant | $141 | 485% |
| Allied Benefit Systems | $141 | 485% |
| Ameriben | $141 | 485% |
| American Family | $141 | 485% |
| American Healthcare Alliance | $141 | 485% |
| American Republic | $141 | 485% |
| Amerihealth | $141 | 485% |
| Aultcare | $141 | 485% |
| Automated Benefit Services | $141 | 485% |
| Auxiant | $141 | 485% |
| Benefit Administrative Systems,Llc | $141 | 485% |
| Boon Chapman | $141 | 485% |
| Cam Administrative Services | $141 | 485% |
| Christian Brother Services | $141 | 485% |
| Christian Brothers Holy Cross | $141 | 485% |
| Claimchoice Adminstrators | $141 | 485% |
| Comprehensive Benefits | $141 | 485% |
| Consociate | $141 | 485% |
| Continental Life Insurance | $141 | 485% |
| Custom Benefit Administrators | $141 | 485% |
| Cypress Benefit Administrators | $141 | 485% |
| Employee Benefit Concepts | $141 | 485% |
| Employee Benefit Management | $141 | 485% |
| Enterprise Group Planning | $141 | 485% |
| Forest County Potawatomi | $141 | 485% |
| Freedom Life Insurance Company | $141 | 485% |
| Group Administrators | $141 | 485% |
| Group Marketing Services | $141 | 485% |
| Guardian | $141 | 485% |
| Health America | $141 | 485% |
| Health Smart | $141 | 485% |
| Healthez | $141 | 485% |
| Healthgram | $141 | 485% |
| Healthscope | $141 | 485% |
| Humana | $141 | 485% |
| Insight | $141 | 485% |
| Intercare | $141 | 485% |
| Jfp Benefit Management | $141 | 485% |
| Jp Farley Corporation | $141 | 485% |
| Key Benefit Administrator | $141 | 485% |
| Liberty Union Life Assurance Co | $141 | 485% |
| Lucent Health | $141 | 485% |
| Luminare Health | $141 | 485% |
| Luminare Health (Detroit) | $141 | 485% |
| Medben | $141 | 485% |
| Medcost | $141 | 485% |
| Medical Mutual | $141 | 485% |
| Mutual Health Services | $141 | 485% |
| Mutual Of Omaha | $141 | 485% |
| Ncas | $141 | 485% |
| Nippon Life Ins | $141 | 485% |
| Nova | $141 | 485% |
| Painters Union Insurance Fund | $141 | 485% |
| Physicians Mutual | $141 | 485% |
| Plumbers Local 98 Insurance Fund | $141 | 485% |
| Prairie States | $141 | 485% |
| Primary Physician Care | $141 | 485% |
| Priority Health | $141 | 485% |
| Professional Benefit Administrators | $141 | 485% |
| Secureone Preferred United Plans | $141 | 485% |
| The Loomis Company | $141 | 485% |
| Trustmark Small Business Benefits | $141 | 485% |
| Unicare | $141 | 485% |
| Unified Group Services | $141 | 485% |
| Us Health And Life | $141 | 485% |
| Valenz | $141 | 485% |
| Varipro | $141 - $144 | 485% |
| Western & Southern Financial Group | $141 | 485% |
| Wps | $141 | 485% |
| First Health | $142 | 489% |