CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Southwest General Health Center

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $105
Cash Discount Price: $146
vs. Medicare Baseline: 3.61x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Southwest General Health Center is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $146. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.61x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$146

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $146 (502%)

Insurance Median: $105 (361%)

Cash: $146 (502% of Medicare)

Ins. Median: $105 (361% 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 361% of the Medicare baseline (a markup of 261%). 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
Medical Mutual	$16 - $18	55%
Medical Mutual-Ohio	$16	55%
Buckeye	$50 - $116	172%
Molina	$50 - $116	172%
Healthsmart	$62	213%
Health Design Plus	$72	248%
Humana	$76 - $116	262%
Clarity Health	$78	268%
Healthspan	$78	268%
Healthsmart Preferred	$87	299%
Ohio Health Choice Plus	$94	323%
Aetna	$105	361%
Summacare	$105	361%
UnitedHealthcare	$105 - $116	361%
Amerihealth Caritas	$116	399%
Blue Cross Blue Shield	$116	399%
Caresource	$116	399%
Coventry	$134	461%
First Health	$134	461%
Ohio Health Choice	$150	516%
Private Healthare Systems	$155	533%
Cigna	$184	633%

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 $146.
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 Southwest General Health Center 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.