CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Decatur Memorial Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $166
Cash Discount Price: $282
vs. Medicare Baseline: 5.07x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Decatur Memorial Hospital is $166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $282. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.07x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$282

Average discount available for prompt cash payment at this facility.

Insurance Median

$166

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: $282 (862%)

Insurance Median: $166 (507%)

Cash: $282 (862% of Medicare)

Ins. Median: $166 (507% 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 507% of the Medicare baseline (a markup of 407%). 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	$28 - $287	86%
Aetna	$30 - $193	92%
Coventry	$30 - $172	92%
Health Alliance	$30 - $191	92%
Humana	$30 - $187	92%
Medicare (plans)	$30 - $31	92%
UnitedHealthcare	$30 - $287	92%
Veterans Administration	$30 - $31	92%
Wellcare	$30	92%
Tricare	$31 - $32	95%
Caterpillar	$38	116%
Medicaid / KanCare	$45 - $46	137%
Illinois Workers Compensation	$49 - $62	150%
Hfn	$58 - $215	177%
Commercial Workers Compensation	$59	180%
Mennonite Churches	$119 - $123	364%
Plain Church Medical Group	$125 - $129	382%
Health Alliance Mh Employee Plan	$127 - $132	388%
Cigna	$129 - $134	394%
6 Degrees Health	$166 - $172	507%
Hopetrust	$166 - $172	507%
Hst	$166 - $172	507%
Phcs Savility	$180 - $187	550%
Phcs Multiplan Ppo	$188 - $195	574%
Healthlink	$190 - $197	581%
Corvel	$199 - $207	608%
Consociate	$205 - $212	626%
Liability	$277 - $287	846%

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 $282.
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 Decatur Memorial 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.