CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Decatur Memorial Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $150
Cash Discount Price: $253
vs. Medicare Baseline: 5.16x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Decatur Memorial Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $253. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.16x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$253

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $253 (871%)

Insurance Median: $150 (516%)

Cash: $253 (871% of Medicare)

Ins. Median: $150 (516% 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 516% of the Medicare baseline (a markup of 416%). 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
Medicaid / KanCare	$9 - $113	31%
Blue Cross Blue Shield	$25 - $255	86%
Aetna	$27 - $171	93%
Coventry	$27 - $153	93%
Health Alliance	$27 - $170	93%
Humana	$27 - $166	93%
Medicare (plans)	$27 - $28	93%
UnitedHealthcare	$27 - $255	93%
Veterans Administration	$27 - $28	93%
Wellcare	$27	93%
Tricare	$28	96%
Caterpillar	$35	120%
Illinois Workers Compensation	$53 - $70	182%
Commercial Workers Compensation	$66	227%
Hfn	$66 - $191	227%
Mennonite Churches	$108 - $110	372%
Plain Church Medical Group	$112 - $115	385%
Health Alliance Mh Employee Plan	$115 - $117	396%
Cigna	$116 - $119	399%
6 Degrees Health	$150 - $153	516%
Hopetrust	$150 - $153	516%
Hst	$150 - $153	516%
Phcs Savility	$162 - $166	557%
Phcs Multiplan Ppo	$170 - $173	585%
Healthlink	$172 - $175	592%
Corvel	$180 - $184	619%
Consociate	$185 - $189	637%
Liability	$250 - $255	860%

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 $253.
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 Decatur Memorial 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.