CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Sherman Oaks Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

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

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Sherman Oaks Hospital is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.10x the Medicare baseline. Located in 4929 Van Nuys Blvd, Sherman Oaks, CA.

Cash / Self-Pay

$36

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: $36 (110%)

Insurance Median: $36 (110%)

Cash: $36 (110% 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
Aids Healthcare Foundation	$18 - $37	55%
Blue Cross Blue Shield	$18	55%
Blue Shield Of Promise	$18	55%
Health Net Of Ca	$18 - $53	55%
L.A Care Health Plan	$18 - $36	55%
Molina	$18 - $36	55%
Traditional Medi-Cal	$18	55%
Alignment	$36	110%
Blue Shield Of Ca, Va	$36	110%
Elite Health Plan	$36	110%
Imperial Health Plan	$36	110%
Managed Health Network	$36	110%
Medicare (plans)	$36	110%
Renal Payer Solutions	$36	110%
Tricare	$36	110%
Usa Senior Care Network	$36	110%
Brand New Day	$37 - $54	113%
Corvel	$41	125%
Zelis Healthcare	$41	125%
Americas Choice Provider Network	$42	128%
Multiplan	$42	128%
Prime Health Services	$42	128%
Three Rivers	$42	128%
Healthsmart Preferred Network	$43	131%
Provider Network Of America	$43	131%
Provider Select	$43	131%
Aetna	$46	141%
Ca Foundation For Medical Center	$48	147%
Worker Comp	$48	147%
Employer Direct Healthcare	$51	156%
Naphcare	$56	171%

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 $36.
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 Sherman Oaks Hospital 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.