CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Shenandoah Medical Center

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $41
Cash Discount Price: $80
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Shenandoah Medical Center is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.41x the Medicare baseline. Located in 300 Pershing Avenue, Shenandoah, IA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $80 (275%)

Insurance Median: $41 (141%)

Cash: $80 (275% of Medicare)

Ins. Median: $41 (141% 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.

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
UnitedHealthcare	$28 - $122	96%
Home State Health Plan Mcaid-All Plans	$40 - $41	138%
Molina Mcd	$40 - $41	138%
Nebraska Total Care Mcaid-All Plans	$40 - $41	138%
Aetna	$41 - $120	141%
Amerigroup Mcaid-All Plans	$41 - $42	141%
Iowa Total Care Mcaid-All Plans	$41 - $42	141%
Molina Mcr - All Other Plans	$41 - $42	141%
Tricare	$41 - $42	141%
Triwest Wellmark - All Plans	$41 - $42	141%
Wellcare Mcr Adv - All Plans	$41 - $42	141%
Midlands Choice-All Plans	$113 - $116	389%
Blue Cross Blue Shield	$216	743%

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 $80.
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 Shenandoah Medical 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.