CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: St Clair Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $35
Cash Discount Price: $24
vs. Medicare Baseline: 1.07x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at St Clair Hospital is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.07x the Medicare baseline. Located in 1000 Bower Hill Road, Pittsburgh, PA.

Cash / Self-Pay

$24

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $24 (73%)

Insurance Median: $35 (107%)

Cash: $24 (73% of Medicare)

Ins. Median: $35 (107% 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

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
Upmc	$12 - $44	37%
Highmark	$28 - $63	86%
Amerihealth	$31	95%
Humana	$31	95%
UnitedHealthcare	$31 - $35	95%
Aetna	$32 - $84	98%
Geisinger	$32	98%
Cigna	$33 - $125	101%
Health Partners	$33	101%
Pa Health And Wellness	$33	101%
The Health Plan	$33 - $75	101%
Lantern	$68	208%

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 $24.
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 St Clair 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.