CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Adventist Health St Helena

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $181
Cash Discount Price: $43
vs. Medicare Baseline: 5.53x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Adventist Health St Helena is $181. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 5.53x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$43

Average discount available for prompt cash payment at this facility.

Insurance Median

$181

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: $43 (131%)

Insurance Median: $181 (553%)

Cash: $43 (131% of Medicare)

Ins. Median: $181 (553% 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 553% of the Medicare baseline (a markup of 453%). 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
Va Medi-Cal	$18	55%
Blue Shield Bh Mcr Adv	$39	119%
Blue Shield Mcr Adv	$39	119%
Kaiser Mcr Adv	$39	119%
Tricare	$39	119%
UnitedHealthcare	$39 - $181	119%
Va Mcr - All Other Plans	$39	119%
Ah Employee Health Plan - All Plans	$70	214%
Aetna	$122	373%
Blue Shield Behav Hlth	$128	391%
Phcs-All Plans	$156	477%
Healthnet-All Plans	$174	532%
Interplan-All Plans	$185	565%
Choicecare-All Plans	$199	608%
Beech Street-All Plans	$213	651%
Cigna	$227	694%
Kaiser-All Other Plans	$233	712%
Health Management Network-All Plans	$241	736%
Galaxy Network-All Plans	$256	782%
Three Rivers-All Plans	$256	782%
Blue Shield Epn-All Other Plans	$286	874%
Blue Shield Non-Epn	$294	898%
Western Growers-All Plans	$297	907%
Blue Cross Blue Shield	$332 - $447	1014%

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 $43.
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 Adventist Health St Helena 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.