CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Hamilton Memorial Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $67
Cash Discount Price: $74
vs. Medicare Baseline: 2.05x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Hamilton Memorial Hospital is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.05x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $74 (226%)

Insurance Median: $67 (205%)

Cash: $74 (226% of Medicare)

Ins. Median: $67 (205% 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 205% of the Medicare baseline (a markup of 105%). 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	$32 - $78	98%
Blue Cross Blue Shield	$32 - $79	98%
Health Alliance	$32 - $70	98%
Medicaid / KanCare	$32 - $35	98%
Medicare (plans)	$32 - $35	98%
UnitedHealthcare	$32 - $62	98%
Wellcare	$32 - $35	98%
Humana	$35	107%
Alliance Coal	$61	186%
Healthscope	$61	186%
Wellfirst (Ssmhic)	$61	186%
Hope Trust	$65	199%
Cigna	$68	208%
Hfn, Inc	$70 - $78	214%
Healthlink	$74 - $78	226%
Multiplan	$74	226%
Siho	$78	238%
Three Rivers Provider	$78	238%
Healthsmart	$83	254%
Stratose	$83	254%

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 $74.
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 Hamilton 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.