CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Mt Sinai Hospital Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $53
Cash Discount Price: $80
vs. Medicare Baseline: 1.62x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Mt Sinai Hospital Medical Center is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.62x the Medicare baseline. Located in 15Th Street at California, Chicago, IL.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $80 (244%)

Insurance Median: $53 (162%)

Cash: $80 (244% of Medicare)

Ins. Median: $53 (162% 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.

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
Partners In Hlth - All Plans	$26 - $65	79%
Blue Cross Blue Shield	$29 - $231	89%
Cigna	$31 - $243	95%
Tricare	$32	98%
Va Healthnet - All Plans	$32	98%
Advocate Physician Prtnrs Mcr	$33	101%
Cenpatico Illinicare Dual	$33	101%
Cenpatico Illinicare Mcr - All Other Plans	$33	101%
Humana	$33 - $508	101%
Lawndale Christian - All Plans	$33	101%
Meridian/Harmony D-Snp - All Plans	$33	101%
Nextlevel Hlth Icp Fhp Aca - All Plans	$33	101%
UnitedHealthcare	$33 - $171	101%
Harmony Behavioral Htlh - All Plans	$34	104%
Molina Mcr - All Other Plans	$35	107%
Oscar - All Plans	$35 - $72	107%
Zing Mcr Adv - All Plans	$35	107%
Advocate Physician Prtnrs - All Other Plans	$37	113%
Ambetter / Centene	$37 - $170	113%
Compsych Ip/Op Only - All Plans	$40 - $97	122%
Healthlink Hmo	$43 - $105	131%
Hfn Platinum	$43 - $105	131%
Healthlink Ppo - All Other Plans	$46 - $113	141%
Multiplan Primary Ntwrk/Phcs - All Other Plans	$46 - $113	141%
Hfn Epo	$53 - $129	162%
Multiplan Complementary Ntwrk	$53 - $129	162%
Hfn Ppo - All Other Plans	$58 - $142	177%
Aetna	$149 - $366	455%
Family Health Network Mcaid - All Plans	$231	706%
Molina Mcaid	$243	742%

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 $80.
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 Mt Sinai Hospital Medical Center 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.