CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Illini Community Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $245
Cash Discount Price: $173
vs. Medicare Baseline: 7.49x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Illini Community Hospital is $245. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $173. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 7.49x the Medicare baseline. Located in 640 W Washington, Pittsfield, IL.

Cash / Self-Pay

$173

Average discount available for prompt cash payment at this facility.

Insurance Median

$245

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: $173 (529%)

Insurance Median: $245 (749%)

Cash: $173 (529% of Medicare)

Ins. Median: $245 (749% 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 749% of the Medicare baseline (a markup of 649%). 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
Humana	$84	257%
Blue Cross Blue Shield	$148 - $245	452%
Blue Access	$173	529%
United Behavioral Health	$173	529%
UnitedHealthcare	$230	703%
Aetna	$245	749%
Blue Preferred	$245	749%
Cigna	$245	749%
Health Link	$245	749%
Private Healthcare Systems-Multi Plan Primary	$245	749%
Health Link Ppo	$259	791%
Private Healthcare Systems-Multi Plan Complementary	$259	791%

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 $173.
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 Illini Community 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.