CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Martin Luther King, Jr. Community Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $219
Cash Discount Price: $139
vs. Medicare Baseline: 6.69x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Martin Luther King, Jr. Community Hospital is $219. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 6.69x the Medicare baseline. Located in 1680 East 120Th Street, Los Angeles, CA.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$219

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: $139 (425%)

Insurance Median: $219 (669%)

Cash: $139 (425% of Medicare)

Ins. Median: $219 (669% 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 669% of the Medicare baseline (a markup of 569%). 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
Alta	$12 - $36	37%
Brand New Day	$12 - $452	37%
Care1St Health	$12 - $36	37%
Molina Healthcare	$13 - $45	40%
La Care Health	$22	67%
Preferred Professional Medical Corporation (Ipa) Of California	$22 - $29	67%
Health Net	$32 - $226	98%
Heritage Provider Network (Hpn)	$34	104%
La Care Health Pasc-Seui	$42	128%
La Care Health Plan	$42	128%
Santa Monica Unite Here	$49	150%
Blue Shield Of California	$299 - $342	914%
UnitedHealthcare	$312 - $323	953%
Multiplan	$583 - $602	1781%

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 $139.
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 Martin Luther King, Jr. Community 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.