CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Adena Fayette Medical Center

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $87
Cash Discount Price: $79
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Adena Fayette Medical Center is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.99x the Medicare baseline. Located in 1430 Columbus Avenue, Washington Ch, OH.

Cash / Self-Pay

$79

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: $79 (272%)

Insurance Median: $87 (299%)

Cash: $79 (272% 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
Blue Cross Blue Shield	$35 - $141	120%
Aetna	$43 - $168	148%
Buckeye Community Health Plan	$43 - $87	148%
Humana	$43 - $87	148%
Medical Mutual Of Ohio	$43 - $160	148%
Medigold	$43 - $87	148%
Molina	$43 - $87	148%
Care Source	$44 - $89	151%
Molina Marketplace	$47 - $96	162%
United Medical Resources Ohcp	$66 - $134	227%
UnitedHealthcare	$66 - $135	227%
Cigna	$72 - $146	248%
Ohio Ppo Connect	$73 - $149	251%
The Health Plan	$73 - $149	251%
Care Source Just4Me	$77 - $157	265%
Medical Mutual Of Ohio Supermed	$79 - $160	272%
First Health	$82 - $167	282%
Ohio Health Choice	$83 - $169	286%
Multiplan/Private Healthcare Systems	$99 - $202	341%
Sidecar Health	$118 - $240	406%

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 $79.
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 Adena Fayette 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.