Physical therapy (therapeutic exercise)
Facility: Scott County Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $121
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 4.16x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 416% of the Medicare baseline (a markup of 316%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 - $127 | 96% |
| Humana | $56 | 193% |
| Blue Cross Blue Shield | $57 | 196% |
| Wppa | $80 - $1,200 | 275% |
| Aetna | $121 | 416% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy (therapeutic exercise), Scott County Hospital in Scott City, KS, lists a gross charge of $134.00. While the facility's negotiated rates with payers like UnitedHealthcare and Wppa range from $28 to $1,200, the median negotiated amount across all five payers is $121.00. This commercial rate is significantly higher than the Medicare benchmark of $29.06, reflecting a markup typical of commercial contracts. For patients with high-deductible plans, paying the cash price directly may be more cost-effective than relying on insurance, as the negotiated rate often exceeds the cash price. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can lower the final cost by bypassing administrative processing fees.
It is important to understand that commercial insurance rates are not always the lowest option available. The data shows that while some payers have a low-end rate of $28, others like Wppa have a high-end rate of $1,200, creating significant variability. Because the facility is a Critical Access Hospital in a specific geographic area, its pricing is benchmarked against Medicare rates, which serve as the objective baseline for fair pricing. If you receive a bill that exceeds the allowed amount, it may be a balance bill resulting from out-of-network services or a discrepancy in the claim. To protect yourself, always request a full itemized bill before paying, ensuring every charge is verified against your plan's coverage. Disputing errors in writing is the most effective way to reduce medical debt, as