CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Jacksonville Memorial Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $170
Cash Discount Price: $280
vs. Medicare Baseline: 5.19x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Jacksonville Memorial Hospital is $170. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $280. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.19x the Medicare baseline. Located in 1600 W Walnut St, Jacksonville, IL.

Cash / Self-Pay

$280

Average discount available for prompt cash payment at this facility.

Insurance Median

$170

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: $280 (855%)

Insurance Median: $170 (519%)

Cash: $280 (855% of Medicare)

Ins. Median: $170 (519% 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 519% of the Medicare baseline (a markup of 419%). 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
Blue Cross Blue Shield	$29 - $283	89%
Coventry	$31 - $45	95%
Health Alliance	$31 - $192	95%
Humana	$31 - $241	95%
Medicare (plans)	$31 - $45	95%
Tricare	$31 - $52	95%
UnitedHealthcare	$33 - $204	101%
Corvel/Corcare	$45 - $69	137%
Illinois Workers Compensation	$49 - $74	150%
Commercial Workers Compensation	$70	214%
Medicaid / KanCare	$71	217%
Molina Healthcare	$71	217%
Health Alliance Mh Employee Plan	$127 - $130	388%
Current Health Network	$152 - $212	464%
6 Degrees Health	$166 - $170	507%
Hope Trust	$166 - $170	507%
Hst	$166 - $170	507%
Cigna	$192 - $196	587%
Aetna	$194 - $226	593%
Healthlink	$235 - $241	718%
Phcs/Multiplan	$249 - $255	761%
Hfn	$263 - $269	804%
Liability	$277 - $283	846%

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 $280.
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 Jacksonville 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.