CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Saint Joseph Hospital-Elgin

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $34
Cash Discount Price: $33
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Saint Joseph Hospital-Elgin is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.04x the Medicare baseline. Located in 77 N Airlite Street, Elgin, IL.

Cash / Self-Pay

$33

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $33 (101%)

Insurance Median: $34 (104%)

Cash: $33 (101% of Medicare)

Ins. Median: $34 (104% 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
Aetna	$31 - $35	95%
Blue Cross Blue Shield	$31 - $47	95%
Humana	$31 - $37	95%
Medicaid / KanCare	$31 - $33	95%
Meridian	$33 - $35	101%
Molina	$33 - $50	101%
Celtic (Wellcare)	$34	104%
Cigna	$34	104%
Clear Spring Health Of Illinois	$34	104%
Devoted Health	$34	104%
Essential Health Partners	$34 - $39	104%
Longevity Health Plan Of Illinois	$34	104%
Medicare (plans)	$34	104%
Ravenswood Physicians Associates Ipa	$34	104%
Resurrection Physicians Provider Group Ipa	$34	104%
Self-Pay	$34	104%
Tricare	$34	104%
United Behavioral	$34	104%
UnitedHealthcare	$34 - $42	104%
Providers Partners Health Plan (Pphp)	$35	107%
Zing Health Provider Network	$35	107%
Harmony Health Plan	$36	110%
Access Community Health Network	$40	122%
Clifton Health Systems	$52	159%
Ambetter / Centene	$54	165%
Hfn Inc	$102	312%
Coventry	$104	318%
Workers Comp	$104	318%
Imagine Health Network, Inc	$149	455%
Community Partners Health Plan	$161	492%

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 $33.
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 Saint Joseph Hospital-Elgin 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.