CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Sycamore Shoals Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97110
  • Insurance Median: $49
  • Cash Discount Price: $31
  • vs. Medicare Baseline: 1.69x Medicare
The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Sycamore Shoals Hospital is $49. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 1.69x the Medicare baseline. Located in 1501 West Elk Avenue, Elizabethton, TN.
Cash / Self-Pay
$31

Average discount available for prompt cash payment at this facility.

Insurance Median
$49

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: $31 (107%)
Insurance Median: $49 (169%)
Cash: $31 (107% of Medicare)
Ins. Median: $49 (169% 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.

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 $24 - $144 83%
Aetna $28 - $131 96%
Amerigroup $28 - $29 96%
Humana $28 96%
Managed Medicaire $28 96%
Medicare (plans) $28 96%
Sentara Health $28 - $57 96%
United Mine Workers Of America $28 96%
UnitedHealthcare $28 - $206 96%
Cigna $29 - $100 100%
Devoted Health Plan $29 100%
Molina Healthcare $29 - $51 100%
Nhc Advantage $29 100%
Wellcare $29 - $206 100%
Optima Health $49 169%
Ambetter / Centene $60 206%
Medcost $72 248%
First Health Coventry $154 530%
Seven Corners, Inc. $206 709%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1501 West Elk Avenue, Elizabethton, TN 37643
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals