CMS Price Transparency Data

Physical therapy (neuromuscular re-education)

Facility: Boston Children's Hospital

Billing Code: 97112 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97112
Insurance Median: $142
Cash Discount Price: $200
vs. Medicare Baseline: 4.34x Medicare

The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Boston Children's Hospital is $142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $200. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 4.34x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$200

Average discount available for prompt cash payment at this facility.

Insurance Median

$142

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: $200 (611%)

Insurance Median: $142 (434%)

Cash: $200 (611% of Medicare)

Ins. Median: $142 (434% 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 434% of the Medicare baseline (a markup of 334%). 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
Cdphp	$98 - $170	299%
Harvard Pilgrim	$102 - $135	312%
Blue Cross Blue Shield	$113 - $132	345%
Unicare	$114	348%
Aetna	$120 - $168	367%
United	$120 - $167	367%
Mgb/Allways	$122 - $148	373%
Tufts Public Plan	$123	376%
Ambetter / Centene	$126	385%
United Ri Nj Ny	$126	385%
Carelon Strategies/Bhs	$130	397%
UnitedHealthcare	$130 - $170	397%
Carelon/Beacon	$150	458%
Fallon	$153 - $154	467%
Health New England	$162	495%
Cigna	$170 - $180	519%
Ets/Lifetrac	$170	519%
Interlink Transplant	$170	519%
Community Health Options	$180	550%
Humana	$180	550%
Coventry/Hcvm/First Health	$184	562%
Multiplan/Phcs	$184 - $190	562%

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 $200.
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 Children's 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.