CMS Price Transparency Data
Physical therapy (neuromuscular re-education)
Facility: Claiborne Memorial Medical Center
Billing Code: 97112 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97112
- Insurance Median: $86
- Cash Discount Price: $101
- vs. Medicare Baseline: 2.63x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Claiborne Memorial Medical Center is $86. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.63x the Medicare baseline. Located in 620 East College Street, Homer, LA.
Cash / Self-Pay
$101
Average discount available for prompt cash payment at this facility.
Insurance Median
$86
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: $101 (309%)
Insurance Median: $86 (263%)
Cash: $101 (309% of Medicare)
Ins. Median: $86 (263% 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 263% of the Medicare baseline (a markup of 163%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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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 |
|---|---|---|
| Aetna | $31 - $66 | 95% |
| Arcadian Community Mcr Hm | $31 | 95% |
| Blue Cross Blue Shield | $31 - $96 | 95% |
| Champus | $31 | 95% |
| Champva | $31 | 95% |
| Cigna | $31 - $76 | 95% |
| Healthy Blue Dual Adv | $31 | 95% |
| Humana | $31 - $101 | 95% |
| Kaiser Foundation Health | $31 | 95% |
| Medicare (plans) | $31 | 95% |
| Peoples Health Network | $31 | 95% |
| Pyramid Claims Mcr Hmo | $31 | 95% |
| Sterling Connect 2 | $31 | 95% |
| Sterling Premier Mc Hmo | $31 | 95% |
| Superior Health Mcr Hmo | $31 | 95% |
| Tenet Mcr Hmo | $31 | 95% |
| Tricare | $31 | 95% |
| United Hc Mcr Hmo | $31 | 95% |
| UnitedHealthcare | $31 - $43 | 95% |
| Universal Hc Mcr Hmo | $31 | 95% |
| Us Dept Of Labor | $31 | 95% |
| Vantage Health Mcr Hmo | $31 | 95% |
| Windsor Sterling Mcr Hmo | $31 | 95% |
| Wps Mvh Vapc3 | $31 | 95% |
| Vantage Health Plan Inc | $33 - $37 | 101% |
| Commercial Insurance | $40 - $101 | 122% |
| Meritain Health | $40 - $66 | 122% |
| Sedgwick Claims Mgmt Serv | $42 - $91 | 128% |
| Workman'S Comp | $42 - $91 | 128% |
| Amerihealth Caritas La | $43 | 131% |
| Community Health Solution | $43 | 131% |
| Correctcare Intergrated | $43 | 131% |
| Healthy Blue | $43 | 131% |
| Louisiana Hc Connections | $43 | 131% |
| Magellan Services | $43 | 131% |
| Medicaid / KanCare | $43 | 131% |
| Coventry Healthcare | $60 | 183% |
| Geha | $71 | 217% |
| Health Plus Of La | $71 - $76 | 217% |
| Apwu Healthplan | $76 | 232% |
| Great West Healthcare | $76 | 232% |
| Phcs | $81 | 247% |
| Ppo Plus | $81 | 247% |
| Aarp | $101 | 309% |
| Accordia National | $101 | 309% |
| Aflac | $101 | 309% |
| Alameda Alliance Forhealt | $101 | 309% |
| American Pioneer | $101 | 309% |
| Benefit Management | $101 | 309% |
| Benesys Inc | $101 | 309% |
| Business Guarantor | $101 | 309% |
| Chubb | $101 | 309% |
| Commercial Sr. Care | $101 | 309% |
| Employee Benefit Services | $101 | 309% |
| Family Life Insurance Co | $101 | 309% |
| Farm Bureau Insurance | $101 | 309% |
| Fiserv Health Benefit | $101 | 309% |
| Gmp | $101 | 309% |
| Group And Pension Admin | $101 | 309% |
| Group Resources | $101 | 309% |
| Haik Minvielle And Grubbs | $101 | 309% |
| Harrington Benefit Svs | $101 | 309% |
| Health Design Plus | $101 | 309% |
| Health Plan | $101 | 309% |
| Healthscope Benefits | $101 | 309% |
| Insurance Management Admi | $101 | 309% |
| Jefferson National | $101 | 309% |
| John Alden Health Ins | $101 | 309% |
| John Hancock | $101 | 309% |
| Liberty Mutual | $101 | 309% |
| Mailhandlers Benefit Plan | $101 | 309% |
| Manhattan Life Ins Co | $101 | 309% |
| Mega Life And Health | $101 | 309% |
| Msa Careguard | $101 | 309% |
| Mutual Of Omaha | $101 | 309% |
| Nalc Health Benefit Plan | $101 | 309% |
| Naphcare Inc. | $101 | 309% |
| New Era Life Ins Co | $101 | 309% |
| Physicians Mutual | $101 | 309% |
| Principal Financial Group | $101 | 309% |
| Prudential Healthcare | $101 | 309% |
| Self Pay | $101 | 309% |
| State Farm | $101 | 309% |
| State Farm Insurance | $101 | 309% |
| State Mutual Insurance Co | $101 | 309% |
| Sterling Investors Life | $101 | 309% |
| Tower Life | $101 | 309% |
| Transamerica Premier Ins | $101 | 309% |
| United American | $101 | 309% |
| United Comm Travelers | $101 | 309% |
| United Teachers | $101 | 309% |
| Usable Administrator | $101 | 309% |
| Visn 16 Cfu | $101 | 309% |
| Wausau Benefits | $101 | 309% |
| Webtpa | $101 | 309% |
| Wells Fargo | $101 | 309% |
| Woodmen Of The World | $101 | 309% |