CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: St Francis Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $141
Cash Discount Price: $96
vs. Medicare Baseline: 4.31x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at St Francis Hospital is $141. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.31x the Medicare baseline. Located in 7Th and Clayton Sts, Wilmington, DE.

Cash / Self-Pay

$96

Average discount available for prompt cash payment at this facility.

Insurance Median

$141

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.73

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.73 (100%)

Cash / Self-Pay: $96 (293%)

Insurance Median: $141 (431%)

Cash: $96 (293% of Medicare)

Ins. Median: $141 (431% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.73 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 431% of the Medicare baseline (a markup of 331%). 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
Blue Cross Blue Shield	$33 - $221	101%
Cigna	$33	101%
Blue Shield - De (Highmark) Medciare Advantage	$34	104%
Highmark Health Options Dual Plan	$34	104%
Medicare (plans)	$34	104%
Aetna	$35 - $96	107%
Coventry	$39	119%
Medicaid / KanCare	$52	159%
Amerihealth	$62 - $144	189%
Meritain	$96	293%
Trustmark Small Business Benefits	$96	293%
Delaware First Health	$137	419%
Devon Health Services	$141	431%
Galaxy Health Network	$141	431%
Multiplan	$141	431%
Prime Health Services	$141	431%
Three Rivers Provider Network	$141	431%
Wc Corvel	$141	431%
Blue Benefit Administrators Of Massachusetts	$221	675%
Blue Care Network	$221	675%
Blue Distinction Transplant	$221	675%
Blue Shield - Ca	$221	675%
Blue Shield - Id (Regence)	$221	675%
Blue Shield - Ny Highmark Northeastern	$221	675%
Blue Shield - Ny Highmark Western	$221	675%
Blue Shield - Pa (Highmark)	$221	675%
Blue Shield - Wa (Regence)	$221	675%
Pace-Trinity Health	$404	1234%
Saint Francis Life	$404	1234%

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 $96.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97112.

Insurance In-Network Protection Plan

Contact your insurance company to confirm St Francis Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97112.
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.