CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Berkshire Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $70
Cash Discount Price: $89
vs. Medicare Baseline: 2.14x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Berkshire Medical Center is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.14x the Medicare baseline. Located in 725 North Street, Pittsfield, MA.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $89 (272%)

Insurance Median: $70 (214%)

Cash: $89 (272% of Medicare)

Ins. Median: $70 (214% 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 214% of the Medicare baseline (a markup of 114%). 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
Cdphp	$26 - $86	79%
Health New England	$26 - $73	79%
Mcd Out Of State	$26 - $73	79%
Medicaid / KanCare	$26 - $73	79%
Comm Tufts Qhpsub (Network)	$28 - $54	86%
Point32Health	$28 - $91	86%
Bmchnp	$30 - $95	92%
Medicare (plans)	$33	101%
Other Government	$33 - $34	101%
Hospice	$34	104%
UnitedHealthcare	$34 - $82	104%
Blue Cross Blue Shield	$35 - $81	107%
Commcare Alliance	$35 - $40	107%
Fallon	$35 - $72	107%
Aetna	$40 - $72	122%
Workers Comp	$56 - $58	171%
Allways Nhp	$60 - $62	183%
Unicare	$60 - $71	183%
Comm Hne Hmo	$64 - $66	196%
Comm Hne Ppo	$67 - $70	205%
Mbhp	$73	223%
Beacon	$78 - $86	238%
Cigna	$83 - $89	254%
Mvp	$83 - $86	254%
Oxford	$83 - $86	254%
First Health	$86 - $91	263%
Connecticare	$88 - $91	269%
Consolidated Health Plans	$88 - $91	269%
Other Commercial	$88 - $91	269%
Phcs	$88 - $91	269%
Self Pay	$88 - $91	269%

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 $89.
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 Berkshire Medical Center 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.