Physical therapy (neuromuscular re-education)
Facility: Clearsky Rehabilitation Hospital Of Elwood St Joseph Llc
Billing Code: 97112 (CPT)
- CPT Billing Code: 97112
- Insurance Median: $54
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 1.65x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Multiplan | $47 - $56 | 144% |
| Cigna | $52 - $62 | 159% |
Consumer Guidance & Cost Commentary
For this Physical therapy (neuromuscular re-education) service at Clearsky Rehabilitation Hospital Of Elwood St Joseph Llc, the facility's negotiated rates with major payers like Cigna and Multiplan range from $52 to $62, while the median negotiated rate across all plans is $54.00. This commercial pricing is significantly higher than the Medicare benchmark of $32.73, reflecting the standard administrative markup and contract structures that insurance companies use to cover claims processing and utilization reviews. Because these negotiated rates often exceed the cash price, patients with high-deductible plans may find it financially advantageous to pay out-of-pocket directly, provided they can secure a "self-pay" or "prompt-pay" discount from the hospital before scheduling.
It is important to note that the facility's billing practices align with standard industry norms where commercial rates are marked up relative to the federal Medicare baseline, which represents the true cost of care delivery. While the data does not provide specific county or state average comparisons for this specific CPT code, the disparity between the Medicare amount and the negotiated rates illustrates the common pricing dynamic where in-network coverage results in higher out-of-pocket costs for patients who have not yet met their deductible. To ensure you are receiving the best possible price, we recommend requesting an itemized bill to verify that no unbundled codes or services not rendered have been charged, and asking the billing department specifically about any prompt-pay discounts available for upfront payment.