CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: South Pointe Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $109
Cash Discount Price: $155
vs. Medicare Baseline: 3.75x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at South Pointe Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.75x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $155 (533%)

Insurance Median: $109 (375%)

Cash: $155 (533% of Medicare)

Ins. Median: $109 (375% 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 375% of the Medicare baseline (a markup of 275%). 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
Aetna	$37 - $239	127%
Humana	$37 - $203	127%
Summacare	$37 - $89	127%
The Health Plan	$37 - $143	127%
United	$37 - $238	127%
UnitedHealthcare	$37 - $148	127%
Upmc	$37 - $143	127%
Valor	$37	127%
Cigna	$38 - $191	131%
Perennial Health	$40	138%
Oscar	$72 - $92	248%
Paramount	$83	286%
Blue Cross Blue Shield	$85 - $155	292%
Buckeye	$85	292%
Molina	$85	292%
Caresource	$86	296%
Amerihealth	$89	306%
Cc Ehp	$95 - $97	327%
Aultcare	$103	354%
Ohcp	$116	399%
Omas	$120	413%
Mmo	$128 - $143	440%
Ohio Healthy	$129	444%
Healthsmart	$131	451%
Php	$143	492%
Gms	$167	575%
Medical Benefit Corp	$167	575%
Quality Care Partners	$167	575%
Consociate Health	$179	616%
Frontpath	$215	740%
Managed Care Services	$215	740%
Multiplan	$215	740%
Tertiary Care Network	$215	740%
Three Rivers	$215	740%

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 $155.
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 South Pointe 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.