CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Rush Memorial Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $163
Cash Discount Price: $183
vs. Medicare Baseline: 4.98x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Rush Memorial Hospital is $163. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $183. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.98x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$183

Average discount available for prompt cash payment at this facility.

Insurance Median

$163

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: $183 (559%)

Insurance Median: $163 (498%)

Cash: $183 (559% of Medicare)

Ins. Median: $163 (498% 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 498% of the Medicare baseline (a markup of 398%). 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
Health Net	$72	220%
Caresource Mcr Adv	$75 - $76	229%
My True Advantage - All Plans	$75 - $76	229%
UnitedHealthcare	$75 - $195	229%
Aetna	$76 - $224	232%
Humana	$76 - $224	232%
Blue Cross Blue Shield	$78 - $179	238%
Today'S Option Mcr Adv-All Plans	$78	238%
Viant Beech St Mcr Adv	$78	238%
Caresource Marketplace-All Other Plans	$121	370%
Cigna	$194 - $195	593%
Phcs-All Plans	$194 - $195	593%
Consumers Life Ins-All Plans	$219 - $220	669%
Coventry/First Health-All Plans	$219 - $220	669%
Sagamore-All Plans	$224	684%
Siho-All Plans	$224	684%
Multiplan-All Plans	$226 - $227	690%
Community Health Alliance-All Plans	$228 - $229	697%
Encore Health Services-All Plans	$238 - $239	727%

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 $183.
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 Rush 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.