CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: HSHS St Elizabeth's Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $166
Cash Discount Price: $150
vs. Medicare Baseline: 5.07x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at HSHS St Elizabeth's Hospital is $166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.07x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.

Cash / Self-Pay

$150

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: $150 (458%)

Insurance Median: $166 (507%)

Cash: $150 (458% 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
Aetna	$31 - $147	95%
Blue Cross Blue Shield	$31 - $209	95%
Clear Spring Health Of Illinois	$31	95%
Health Alliance Medical Plans	$31 - $178	95%
Health Partners	$31	95%
Humana	$31	95%
Sae Hospice	$31	95%
UnitedHealthcare	$31 - $209	95%
Molina Healthcare	$32 - $33	98%
Meridian Health Plan	$34	104%
Amish Community	$59	180%
Celtic Insurance Company	$66	202%
Naphcare	$69	211%
Claim Doc	$77	235%
Hopetrust	$77	235%
Wellfirst	$135	412%
First Health	$156	477%
Cigna	$165 - $209	504%
Healthlink	$166 - $209	507%
Caterpillar, Inc.	$168	513%
Consociate Group	$184	562%
Choicecare	$188	574%
Healthcare Finest Network (Hfn)	$188	574%
Multiplan/Phcs	$188	574%
Provider Network Of America	$188	574%
City Of Springfield	$209	639%
Current Health Solutions	$209	639%
Healthscope	$209	639%
Illinois Breast And Cervical Cancer Program	$209	639%
Interplan	$209	639%
Live360	$209	639%
Wexford	$209	639%

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 $150.
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 HSHS St Elizabeth's 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.