CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: City of Hope National Medical Center

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $137
Cash Discount Price: $157
vs. Medicare Baseline: 4.19x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at City of Hope National Medical Center is $137. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $157. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.19x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$157

Average discount available for prompt cash payment at this facility.

Insurance Median

$137

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: $157 (480%)

Insurance Median: $137 (419%)

Cash: $157 (480% of Medicare)

Ins. Median: $137 (419% 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 419% of the Medicare baseline (a markup of 319%). 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
Health Net	$10 - $199	31%
Heritage Provider Network	$12 - $119	37%
Cal Optima	$14 - $36	43%
Inland Empire	$21 - $136	64%
Prime Healthcare Keenan	$62 - $163	189%
Blue Cross Blue Shield	$72 - $340	220%
UnitedHealthcare	$81 - $340	247%
Blue Shield	$86 - $340	263%
Blue Shield Promise	$101 - $119	309%
Cencal	$116 - $136	354%
La Care Health	$116 - $136	354%
Kaiser	$130 - $153	397%
Aetna	$144 - $170	440%
Gold Coast	$144 - $170	440%
Molina	$144 - $221	440%
Cigna	$155 - $183	474%
Facey	$159 - $187	486%
Healthcare Partners	$168 - $197	513%
St. Joseph Heritage	$173 - $204	529%
Primecare Medical Network	$188 - $221	574%
First Health	$223 - $262	681%
Blue Shield Covca	$238	727%
Phcs Multiplan	$260 - $306	794%

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 $157.
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 City of Hope National 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.