CMS Price Transparency Data

Physical therapy (therapeutic exercise)

Facility: Hamilton Memorial Hospital

Billing Code: 97110 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97110
Insurance Median: $69
Cash Discount Price: $74
vs. Medicare Baseline: 2.37x Medicare

The contracted insurance negotiated median rate for a Physical therapy (therapeutic exercise) at Hamilton Memorial Hospital is $69. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 2.37x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$69

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: $74 (255%)

Insurance Median: $69 (237%)

Cash: $74 (255% of Medicare)

Ins. Median: $69 (237% 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 237% of the Medicare baseline (a markup of 137%). 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
Aetna	$28 - $78	96%
Blue Cross Blue Shield	$28 - $79	96%
Health Alliance	$28 - $70	96%
Medicare (plans)	$28 - $35	96%
UnitedHealthcare	$28 - $62	96%
Wellcare	$28 - $35	96%
Medicaid / KanCare	$32 - $35	110%
Humana	$34 - $35	117%
Alliance Coal	$60 - $61	206%
Healthscope	$60 - $61	206%
Wellfirst (Ssmhic)	$60 - $61	206%
Hope Trust	$65	224%
Cigna	$68	234%
Hfn, Inc	$69 - $78	237%
Healthlink	$73 - $78	251%
Multiplan	$73 - $74	251%
Siho	$77 - $78	265%
Three Rivers Provider	$77 - $78	265%
Healthsmart	$82 - $83	282%
Stratose	$82 - $83	282%

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 $74.
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 Hamilton 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.