CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Texas Childrens Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $192
Cash Discount Price: $203
vs. Medicare Baseline: 6.61x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Texas Childrens Hospital is $192. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $203. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 6.61x the Medicare baseline. Located in 6621 Fannin Street, Houston, TX.

Cash / Self-Pay

$203

Average discount available for prompt cash payment at this facility.

Insurance Median

$192

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: $203 (699%)

Insurance Median: $192 (661%)

Cash: $203 (699% of Medicare)

Ins. Median: $192 (661% 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 661% of the Medicare baseline (a markup of 561%). 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
First Care Health Plan	$81 - $195	279%
UnitedHealthcare	$81 - $195	279%
Driscoll Children'S Health Plan Mcd	$90 - $92	310%
Molina Mcd	$90 - $92	310%
Blue Cross Blue Shield	$105 - $192	361%
Community Health Choice	$106 - $195	365%
Community First Health Plan Mcd	$120 - $122	413%
Cook Children'S Health Plan	$120 - $122	413%
Cigna	$171 - $195	588%
Aetna	$192 - $195	661%
Kelseycare	$195 - $198	671%
Healthsmart	$210 - $214	723%
Evolutions Healthcare	$225 - $229	774%
First Health	$264 - $290	908%
Multiplan	$270 - $274	929%
Galaxy Health Network	$285 - $290	981%

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 $203.
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 Texas Childrens 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.