CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Mc Donough District Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $139
Cash Discount Price: $94
vs. Medicare Baseline: 4.78x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Mc Donough District Hospital is $139. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 4.78x the Medicare baseline. Located in 525 East Grant Street, Macomb, IL.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$139

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: $94 (323%)

Insurance Median: $139 (478%)

Cash: $94 (323% of Medicare)

Ins. Median: $139 (478% 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 478% of the Medicare baseline (a markup of 378%). 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
Health Alliance	$17 - $146	58%
Hfn	$26 - $148	89%
UnitedHealthcare	$26 - $148	89%
Aetna	$28 - $164	96%
Humana	$28 - $148	96%
Medicaid / KanCare	$28 - $164	96%
Medicare (plans)	$28	96%
Meridian	$28	96%
Molina	$28 - $164	96%
Mutual Medical	$28 - $164	96%
Tricare	$28	96%
Veteran Affairs	$28	96%
Blue Cross Blue Shield	$45 - $164	155%
Springfield Health	$128 - $134	440%
Consociate	$133 - $139	458%
Trilogy	$133 - $139	458%
Blue Choice	$140 - $148	482%
Current Health	$140 - $148	482%
Healthlink	$140 - $154	482%
Preferred Plan	$148 - $156	509%

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 $94.
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 Mc Donough District Hospital 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.