CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Mayers Memorial Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $122
Cash Discount Price: $143
vs. Medicare Baseline: 3.73x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Mayers Memorial Hospital is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $143. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 3.73x the Medicare baseline. Located in 43563 Hwy 299 East, Fall River Mills, CA.

Cash / Self-Pay

$143

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

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: $143 (437%)

Insurance Median: $122 (373%)

Cash: $143 (437% of Medicare)

Ins. Median: $122 (373% 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 373% of the Medicare baseline (a markup of 273%). 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
Medi-Cal	$18	55%
Partnership Hp-All Plans	$70	214%
Blue Shield Ca Va	$90	275%
Blue Shield Mcr Adv	$90	275%
Arcadian Health Services-All Plans	$94	287%
Health Net Mcr Adv	$94	287%
Tricare	$94	287%
Blue Cross Blue Shield	$95 - $122	290%
Health Net Prison	$103	315%
Imperial Health Plan-All Plans	$107	327%
Blue Shield Ca Exchange	$122	373%
Blue Shield-All Other Plans	$136	416%
Cigna	$136	416%
Corvel Ppo-All Plans	$136	416%
Coventry/First Health-All Plans	$136	416%
Hmn-All Plans	$136	416%
Integrated Hp-All Plans	$136	416%
Interplan-All Plans	$136	416%
Multiplan Phcs-All Plans	$136	416%
Pfmc-All Plans	$136	416%
Superior Ca-All Plans	$136	416%
Health Net-All Other Plans	$142	434%
Pacificare-All Plans	$143	437%

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 $143.
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 Mayers Memorial 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.