CMS Price Transparency Data
Physical therapy (neuromuscular re-education)
Facility: Whittier Hospital Medical Center
Billing Code: 97112 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97112
- Insurance Median: $77
- Cash Discount Price: $18
- vs. Medicare Baseline: 2.35x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Whittier Hospital Medical Center is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $18. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.35x the Medicare baseline. Located in 9080 Colima Rd, Whittier, CA.
Cash / Self-Pay
$18
Average discount available for prompt cash payment at this facility.
Insurance Median
$77
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: $18 (55%)
Insurance Median: $77 (235%)
Cash: $18 (55% of Medicare)
Ins. Median: $77 (235% 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 235% of the Medicare baseline (a markup of 135%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $5 - $293 | 15% |
| Aids Healthcare Foundation | $10 - $36 | 31% |
| Allied Physicians | $10 - $54 | 31% |
| Kaiser Foundation | $10 - $127 | 31% |
| Synermed | $10 - $36 | 31% |
| Physicians Healthways Medical Corporation | $11 | 34% |
| Ahmc Medi-Cal Reciprocity Agreement | $12 | 37% |
| Alta Med Health Network | $12 - $36 | 37% |
| Altamed Health Services Corporation | $12 | 37% |
| Beverly Hospital | $12 - $40 | 37% |
| Brand New Day | $12 - $44 | 37% |
| Emanate Health | $12 - $45 | 37% |
| Health Net | $12 - $108 | 37% |
| Healthy Way La | $12 | 37% |
| Heritage Provider Network | $12 - $49 | 37% |
| La Care Healthy Families/Healthy Kids | $12 | 37% |
| Non Contracted Medi-Cal | $12 | 37% |
| Physician Healthways | $12 - $18 | 37% |
| Prospect Health Plan | $12 - $58 | 37% |
| Avanti | $14 - $43 | 43% |
| Care First Health Plan | $14 | 43% |
| County Of Los Angeles Dept Of Health Services | $14 | 43% |
| Hollywood Presbyterian Adv Med Mcal | $14 | 43% |
| Hollywood Presbyterian Medpoint Mcal | $14 | 43% |
| La Care Health Plan | $14 - $100 | 43% |
| Medi Caid/ Medi Cal | $14 | 43% |
| Monarch Healthplan | $14 | 43% |
| Caloptima | $17 - $36 | 52% |
| Veterans Administration | $25 | 76% |
| Applecare Medical Group | $30 | 92% |
| Aetna | $32 - $132 | 98% |
| Fmc Los Angeles County | $32 - $136 | 98% |
| Interplan Health Group | $32 | 98% |
| Athens Administrators Ahmc Work Comp | $33 | 101% |
| Misc 1 | $33 | 101% |
| Multiplan Wc | $33 | 101% |
| Ahmc Reciprocity | $34 - $54 | 104% |
| Ahmc Reciprocity Agreement Senior/Commercial | $34 - $54 | 104% |
| Wear And Wood | $34 - $72 | 104% |
| Alignment Health Plan | $36 | 110% |
| Alta Los Angeles Hospitals Inc | $36 | 110% |
| Apa/Aco Inc | $36 | 110% |
| Blue Shield Of California | $36 - $433 | 110% |
| Caremore | $36 | 110% |
| Central Health Plan | $36 | 110% |
| Cov19 Hrsa Uninsured Testing And Treatment Fund | $36 | 110% |
| Easy Choice Health Plan | $36 | 110% |
| Humana | $36 | 110% |
| La Care Covered Direct | $36 | 110% |
| Medicare (plans) | $36 - $37 | 110% |
| Pacific Alliance Medical Center | $36 | 110% |
| Pacificare Of California | $36 | 110% |
| Private Pay | $36 | 110% |
| Scan Health Plan | $36 | 110% |
| Self-Pay | $36 | 110% |
| Tricare | $36 | 110% |
| Molina Healthcare Of California | $37 | 113% |
| San Miguel Health Plan | $40 | 122% |
| Chinatown Service Center Pace | $43 | 131% |
| Ahmc Health | $45 | 137% |
| Knox-Keene Act | $45 | 137% |
| Molina Medical Center | $45 - $71 | 137% |
| Central Health Plan Of California | $46 - $72 | 141% |
| UnitedHealthcare | $55 - $267 | 168% |
| Capnet | $60 | 183% |
| Pacific Independent Physician Association | $60 | 183% |
| Prospect Medical | $63 - $100 | 192% |
| Edward Medical Group | $65 | 199% |
| Allied Physicians Ipa | $69 | 211% |
| Care 1St Health Plan | $69 - $109 | 211% |
| New Horizon Medical Group Inc | $69 - $109 | 211% |
| Cost Containment | $75 - $118 | 229% |
| Universal Care | $75 - $127 | 229% |
| Asi/Flex | $80 - $127 | 244% |
| Us Comp Care | $80 - $127 | 244% |
| Value Healthplan Of California | $80 - $127 | 244% |
| Community Care Network | $86 - $136 | 263% |
| Coventry Health Care | $86 - $136 | 263% |
| Coventry Health Care National Network | $86 - $136 | 263% |
| Interplan Corporation | $86 - $136 | 263% |
| Managed Care Administrators | $86 - $136 | 263% |
| Prohealth | $86 - $136 | 263% |
| Health Net Inc | $89 - $135 | 272% |
| Davita Healthcare Partners | $94 | 287% |
| Multiplan | $98 - $154 | 299% |
| Healthnet | $109 - $234 | 333% |
| Cigna | $115 - $181 | 351% |
| Commercial Non Contract | $115 - $181 | 351% |
| Medi-Cal Sub Acute | $115 - $181 | 351% |
| One Legacy | $115 - $181 | 351% |
| Great-West Healthcare Of California | $2,500 | 7638% |