CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Saint Agnes Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $105
Cash Discount Price: $105
vs. Medicare Baseline: 3.21x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Saint Agnes Medical Center is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.21x the Medicare baseline. Located in 1303 E Herndon Ave, Fresno, CA.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $105 (321%)

Insurance Median: $105 (321%)

Cash: $105 (321% of Medicare)

Ins. Median: $105 (321% 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 321% of the Medicare baseline (a markup of 221%). 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
Correctcare Integrated Health	$21	64%
Medi-Cal Healthnet	$23 - $26	70%
Blue Cross Blue Shield	$25 - $358	76%
Aetna	$34 - $111	104%
Humana	$34 - $36	104%
Medicare (plans)	$34 - $36	104%
UnitedHealthcare	$35 - $566	107%
Welbe Health	$36	110%
Align Senior Care	$40	122%
Kaiser Permanente	$60	183%
Advantek Central Usd	$78	238%
Blue Shield - Ca	$78 - $358	238%
Meritain	$105	321%
St Agnes Nicu Valley Childrens Hospital	$105	321%
Trustmark Small Business Benefits	$105	321%
Healthnet	$110 - $132	336%
Allied Benefit Systems	$111	339%
Boon Chapman	$111	339%
Coventry	$111	339%
Hap	$111	339%
Webtpa	$111	339%
Cba Network By Design	$122	373%
Network Health	$122	373%
Allegiance	$125	382%
American Postal Workers Secondary	$125	382%
Cigna	$125	382%
Blue Benefit Administrators Of Massachusetts	$358	1094%
Blue Care Network	$358	1094%
Blue Distinction Transplant	$358	1094%
Blue Shield - Id (Regence)	$358	1094%
Blue Shield - Ny Highmark Northeastern	$358	1094%
Blue Shield - Ny Highmark Western	$358	1094%
Blue Shield - Pa (Highmark)	$358	1094%
Blue Shield - Wa (Regence)	$358	1094%
Geha	$558	1705%

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 $105.
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 Saint Agnes 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.