CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Adventist Health and Rideout

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $204
Cash Discount Price: $62
vs. Medicare Baseline: 6.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Adventist Health and Rideout is $204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 6.23x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$204

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: $62 (189%)

Insurance Median: $204 (623%)

Cash: $62 (189% of Medicare)

Ins. Median: $204 (623% 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 623% of the Medicare baseline (a markup of 523%). 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
Kaiser Mcal	$18	55%
Medi-Cal	$18	55%
Bc Mcal	$19	58%
Ca Health And Wellness- All Plans	$22	67%
Celtic Mcaid-All Plans	$22	67%
Kaiser Mcr Adv	$34	104%
Tricare	$34	104%
UnitedHealthcare	$34 - $243	104%
Blue Cross Blue Shield	$35 - $216	107%
Healthnet Mcal	$56	171%
Ah Employee Health Plan - All Plans	$62	189%
Aetna	$198	605%
Healthnet Comm-All Other Plans	$204	623%
Kaiser-All Other Plans	$213	651%
Blue Shield Uc Care Members	$224	684%
Cigna	$239	730%
First Health-All Plans	$245	749%
Phcs-All Plans	$246	752%
Interplan-All Plans	$252	770%
Blue Shield-All Other Plans	$266	813%
Multiplan-All Plans	$266	813%
Partnership Hp Mcal -All Plans	$462	1412%

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 $62.
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 and Rideout 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.