CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Fairfield Medical Center

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $87
Cash Discount Price: $75
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Fairfield Medical Center is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $75. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.99x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

$75

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $75 (258%)

Insurance Median: $87 (299%)

Cash: $75 (258% of Medicare)

Ins. Median: $87 (299% 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 299% of the Medicare baseline (a markup of 199%). 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
Humana	$25 - $159	86%
Aetna	$27 - $110	93%
Blue Cross Blue Shield	$27 - $26,250	93%
Buckeye Community Health	$27 - $83	93%
Medical Mutual	$27 - $33,500	93%
Medicare (plans)	$27	93%
Caresource	$28 - $80	96%
Medigold	$28	96%
Molina	$28 - $79	96%
The Health Plan	$28 - $116	96%
UnitedHealthcare	$28 - $136	96%
Va Ccn	$28	96%
Valor Health Plan	$28	96%
Bwc	$39	134%
Oscar	$52	179%
Medicaid / KanCare	$79	272%
Amerihealth Caritas Ohio	$83	286%
Allied Benefit Systems	$116	399%
Meritain Health	$116	399%
Quality Care Partners/Ohio Ppo Connect	$120	413%
The Ohio State Health Plan	$129	444%
Cigna	$138	475%
Ohio Healthy	$157	540%
Multiplan	$159	547%
Miscellaneous Plans	$167	575%

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 $75.
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 Fairfield 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.