CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Community Hospital of Staunton

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $128
Cash Discount Price: $85
vs. Medicare Baseline: 3.91x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Community Hospital of Staunton is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.91x the Medicare baseline. Located in 400 N Caldwell St, Staunton, IL.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $85 (260%)

Insurance Median: $128 (391%)

Cash: $85 (260% of Medicare)

Ins. Median: $128 (391% 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 391% of the Medicare baseline (a markup of 291%). 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
Tricare	$30 - $57	92%
Medicare (plans)	$31 - $59	95%
Clear Spring Health Ma	$32 - $60	98%
Self Pay	$70 - $99	214%
Medicaid / KanCare	$75 - $198	229%
Cigna	$91 - $128	278%
Blue Cross Blue Shield	$106 - $198	324%
Healthlink	$106 - $168	324%
Health Alliance Commercial	$113 - $198	345%
Aetna	$114 - $198	348%
Multiplan/Phcs	$120 - $168	367%
Beech Street	$128 - $180	391%
UnitedHealthcare	$141 - $408	431%

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 $85.
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 Community Hospital of Staunton 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.