CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: UCI Health-Orange

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $46
Cash Discount Price: $68
vs. Medicare Baseline: 1.41x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at UCI Health-Orange is $46. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.41x the Medicare baseline. Located in 101 City Drive South, Orange, CA.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$46

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: $68 (208%)

Insurance Median: $46 (141%)

Cash: $68 (208% of Medicare)

Ins. Median: $46 (141% 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
Aetna	$34	104%
Health Net	$35	107%
Blue Shield	$36	110%
Premier Health	$38	116%
Kaiser	$40 - $89	122%
Heritage Provider Network	$50	153%
Ahmc	$52	159%
Primecare Medical Network	$53	162%
Alpha Care Medical Group	$55	168%
Oscar Health Plan	$58	177%

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 $68.
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 UCI Health-Orange 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.