CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Pinckneyville Community Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $164
Cash Discount Price: $209
vs. Medicare Baseline: 5.64x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Pinckneyville Community Hospital is $164. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $209. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 5.64x the Medicare baseline. Located in 5383 State Route 154, Pinckneyville, IL.

Cash / Self-Pay

$209

Average discount available for prompt cash payment at this facility.

Insurance Median

$164

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: $209 (719%)

Insurance Median: $164 (564%)

Cash: $209 (719% of Medicare)

Ins. Median: $164 (564% 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 564% of the Medicare baseline (a markup of 464%). 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
Humana	$74 - $81	255%
Umwa Mcr Adv - All Plans	$74 - $81	255%
UnitedHealthcare	$74 - $180	255%
Wellcare Mcr Adv - All Plans	$74 - $81	255%
Aetna	$75 - $197	258%
Blue Cross Blue Shield	$143 - $197	492%
Healthlink Hmo	$156 - $172	537%
Phcs - All Other Plans	$163 - $180	561%
Cigna	$164 - $181	564%
Healthlink Ppo - All Other Plans	$164 - $181	564%
Healthlink Work Comp	$164 - $181	564%
Phcs Savility	$169 - $186	582%
Multiplan - All Plans	$179 - $197	616%
Ambetter / Centene	$197	678%
Medicaid / KanCare	$197	678%

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 $209.
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 Pinckneyville Community 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.