CMS Price Transparency Data
Physical therapy (neuromuscular re-education)
Facility: Saint Joseph Regional Medical Center
Billing Code: 97112 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97112
- Insurance Median: $59
- Cash Discount Price: $563
- vs. Medicare Baseline: 1.80x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Saint Joseph Regional Medical Center is $59. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $563. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.80x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$563
Average discount available for prompt cash payment at this facility.
Insurance Median
$59
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: $563 (1720%)
Insurance Median: $59 (180%)
Cash: $563 (1720% of Medicare)
Ins. Median: $59 (180% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Hospice Of Marshall County | $17 - $43 | 52% |
| Hospice Of St Joseph County | $17 - $43 | 52% |
| Aetna | $18 - $109 | 55% |
| Blue Cross Blue Shield | $18 - $186 | 55% |
| Medicaid / KanCare | $18 - $186 | 55% |
| Plain Church Group | $18 - $45 | 55% |
| UnitedHealthcare | $18 - $186 | 55% |
| Medicare (plans) | $32 | 98% |
| Meridian Complete | $32 | 98% |
| Pace-Trinity Health | $32 | 98% |
| County Coroner | $33 | 101% |
| Provider Partners Health Plan Of Indiana | $35 | 107% |
| Notre Dame Athletic Association | $37 - $92 | 113% |
| Wc Notre Dame | $37 - $92 | 113% |
| Luminare Health (Detroit) | $38 - $100 | 116% |
| Ameriben | $40 - $100 | 122% |
| Encore Health | $40 - $104 | 122% |
| Auxiant | $42 - $139 | 128% |
| Indiana Criminal Justice Inst | $42 - $104 | 128% |
| Key Benefit Administrator | $42 - $104 | 128% |
| Western & Southern Financial Group | $42 - $104 | 128% |
| Cigna | $43 - $107 | 131% |
| Geha | $43 - $106 | 131% |
| Group Administrators | $43 - $107 | 131% |
| Health Partners | $43 - $107 | 131% |
| Healthscope | $43 - $106 | 131% |
| Mvp | $43 - $107 | 131% |
| Prairie States | $43 - $107 | 131% |
| Priority Health | $43 - $107 | 131% |
| Professional Benefit Administrators | $43 - $107 | 131% |
| Sagamore Health Network | $43 - $124 | 131% |
| Sisco Benefits | $43 - $107 | 131% |
| Student Insurance Cma | $43 - $106 | 131% |
| Unified Group Services | $43 - $107 | 131% |
| Allied Benefit Systems | $44 - $109 | 134% |
| Asr Health Benefits | $44 - $109 | 134% |
| Christian Brother Services | $44 - $109 | 134% |
| Employee Benefit Management | $44 - $109 | 134% |
| Medical Mutual | $44 - $109 | 134% |
| Meritain | $44 - $109 | 134% |
| Preferred One | $44 - $109 | 134% |
| Rural Carrier Health Benefit Plan | $44 - $109 | 134% |
| Webtpa | $44 - $109 | 134% |
| Physicians Health Plan Northern Indiana Health Insurance | $47 - $95 | 144% |
| St Joseph County Hlth Dpt | $47 | 144% |
| Caresource | $49 | 150% |
| Siho Insurance Services | $51 | 156% |
| Goshen Preferred Network | $52 - $144 | 159% |
| Christian Brothers Holy Cross | $54 - $134 | 165% |
| Signature Care | $54 - $134 | 165% |
| Blue Benefit Administrators Of Massachusetts | $63 | 192% |
| Blue Care Network | $63 | 192% |
| Blue Distinction Transplant | $63 | 192% |
| Blue Shield - Ca | $63 | 192% |
| Blue Shield - Id (Regence) | $63 | 192% |
| Blue Shield - Ny Highmark Northeastern | $63 | 192% |
| Blue Shield - Ny Highmark Western | $63 | 192% |
| Blue Shield - Pa (Highmark) | $63 | 192% |
| Blue Shield - Wa (Regence) | $63 | 192% |
| Bankers Life Casualty | $67 - $167 | 205% |
| Bureau Of Disability | $67 - $167 | 205% |
| Wc Align Network | $67 - $167 | 205% |
| Custom Design Benefits | $68 | 208% |
| Managed Health Services - Indiana | $186 | 568% |
| Mdwise | $186 | 568% |