CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Community Memorial Hospital - Ventura

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $36
Cash Discount Price: $172
vs. Medicare Baseline: 1.10x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Community Memorial Hospital - Ventura is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $172. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.10x the Medicare baseline. Located in 147 North Brent Street, Ventura, CA.

Cash / Self-Pay

$172

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $172 (526%)

Insurance Median: $36 (110%)

Cash: $172 (526% of Medicare)

Ins. Median: $36 (110% 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
Medi-Cal	$14	43%
Non Contracted	$14 - $35	43%
Medicaid / KanCare	$20 - $100	61%
Gold Coast Health Plan	$21 - $100	64%
Aetna	$27 - $193	82%
Blue Cross Blue Shield	$35 - $48	107%
California Workers Compensation	$35	107%
Medicare (plans)	$35 - $36	107%
Seaview	$35	107%
Tricare	$35	107%
Wellcare Of California	$35	107%
Alignment Health Plan	$36	110%
Humana	$36	110%
Scan Health Plan	$36	110%
UnitedHealthcare	$36 - $420	110%
Valley Care	$46 - $72	141%
Ventura County Health Care Plan	$72	220%
Multiplan	$172	526%
Health Net Commercial	$286	874%
Cigna	$290	886%
Kaiser Commercial	$528	1613%
Blue Shield Epn	$578	1766%
Blue Shield Commercial	$626	1913%

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 $172.
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 Community Memorial Hospital - Ventura 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.