CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Woodlawn Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $123
Cash Discount Price: $126
vs. Medicare Baseline: 3.76x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Woodlawn Hospital is $123. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.76x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$126

Average discount available for prompt cash payment at this facility.

Insurance Median

$123

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: $126 (385%)

Insurance Median: $123 (376%)

Cash: $126 (385% of Medicare)

Ins. Median: $123 (376% 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 376% of the Medicare baseline (a markup of 276%). 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	$37 - $160	113%
Blue Cross Blue Shield	$37 - $168	113%
Caresource Mcaid Hip	$37	113%
Caresource Mcr Adv	$37	113%
Humana	$37 - $130	113%
Mdwise Mcaid Excel Hip	$37	113%
Mhs Exch Mrktplce-All Other Plans	$37	113%
Mhs Mcaid Hip	$37	113%
UnitedHealthcare	$37 - $168	113%
Mhs Mcr Adv	$38	116%
Caresource Exch - All Other Plans	$48	147%
Ambetter / Centene	$49	150%
Partners Direct Health-All Plans	$114	348%
Cigna	$120 - $143	367%
Parkview Health Plans-All Plans	$126	385%
Sagamore All Other Grps - All Other Plans	$141	431%
Encore Comm-All Plans	$143	437%
Phcs/Multiplan-All Plans	$156	477%
Community Health Alliance-All Plans	$160	489%
Caresource Mcaid Hww	$168	513%
Mhs Mcaid Hcc	$168	513%
Mhs Mcaid Hhw	$168	513%

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 $126.
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 Woodlawn 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.