CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Boston Medical Center-Brighton

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $51
Cash Discount Price: $59
vs. Medicare Baseline: 1.56x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Boston Medical Center-Brighton is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 1.56x the Medicare baseline. Located in 736 Cambridge Street, Nevins Building, Brighton, MA.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $59 (180%)

Insurance Median: $51 (156%)

Cash: $59 (180% of Medicare)

Ins. Median: $51 (156% 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
Aetna	$36 - $96	110%
Blue Cross Blue Shield	$36 - $210	110%
Humana	$36	110%
Medicare (plans)	$36 - $38	110%
Neighborhood Pace [1206]	$36	110%
Senior Whole Health [1210]	$36	110%
Ubh Hphc [8016]	$36	110%
United Community Plan [1202]	$36	110%
UnitedHealthcare	$36	110%
Veterans Admin [9003]	$36	110%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$36	110%
Cca [1215]	$38	116%
Zzzcca Onecare [1216]	$38	116%
Eternalhealth [1227]	$39	119%
Fallon [8008]	$47	144%
Unicare [8004]	$51	156%
Wellpoint [2034]	$51	156%
Cigna	$60 - $119	183%
Meritain Health [1023]	$96	293%
Mass General Brigham Health Plan Commercial [8009]	$99	302%
Mass General Brigham Health Plan Prime [7003]	$99	302%
Tufts [8002]	$104 - $119	318%
Harvard Pilgrim Health Care [8001]	$259	791%
Hsn Bad Debt [4003]	$475	1451%
Hsn Confidential [4007]	$475	1451%
Hsn Dental [4006]	$475	1451%
Hsn Partial [4002]	$475	1451%
Hsn [4001]	$475	1451%

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 $59.
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 Boston Medical Center-Brighton 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.