CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Adventist Health Mendocino Coast

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $84
Cash Discount Price: $95
vs. Medicare Baseline: 2.57x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Adventist Health Mendocino Coast is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $95. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.57x the Medicare baseline. Located in 700 River Drive, Fort Bragg, CA.

Cash / Self-Pay

$95

Average discount available for prompt cash payment at this facility.

Insurance Median

$84

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: $95 (290%)

Insurance Median: $84 (257%)

Cash: $95 (290% of Medicare)

Ins. Median: $84 (257% 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 257% of the Medicare baseline (a markup of 157%). 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	$12 - $18	37%
Partnership Hp Mcal-All Plans	$18 - $53	55%
Blue Cross Blue Shield	$32 - $470	98%
Cigna	$34 - $158	104%
Tricare	$34 - $99	104%
UnitedHealthcare	$34 - $164	104%
Ah Employee Health Plan - All Plans	$38 - $106	116%
Blue Shield Epn	$44 - $77	134%
Blue Shield - All Other Plans	$46 - $156	141%
Healthnet - All Plans	$50 - $132	153%
Ahcc - All Plans	$84 - $183	257%
Beech Street - All Plans	$84 - $183	257%
Great West Hmo/Pos/Epo/Oa	$84 - $132	257%
Great West Ppo - All Other Plans	$84 - $142	257%
Multiplan - All Plans	$84 - $142	257%

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 $95.
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 Adventist Health Mendocino Coast 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.