CMS Price Transparency Data
Physical therapy (neuromuscular re-education)
Facility: Mercy Health Saint Mary's
Billing Code: 97112 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97112
- Insurance Median: $94
- Cash Discount Price: $84
- vs. Medicare Baseline: 2.87x Medicare
The contracted insurance negotiated median rate for a Physical therapy (neuromuscular re-education) at Mercy Health Saint Mary's is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $84. Compared to the federal Medicare reimbursement reference rate of $32.73, this hospital’s rate is 2.87x the Medicare baseline. Located in 200 Jefferson Avenue Se, Grand Rapids, MI.
Cash / Self-Pay
$84
Average discount available for prompt cash payment at this facility.
Insurance Median
$94
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: $84 (257%)
Insurance Median: $94 (287%)
Cash: $84 (257% of Medicare)
Ins. Median: $94 (287% 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 287% of the Medicare baseline (a markup of 187%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $17 - $62 | 52% |
| Medicaid / KanCare | $17 - $18 | 52% |
| Access Health | $22 | 67% |
| Aetna | $31 - $81 | 95% |
| Blue Care Network Advantage | $31 | 95% |
| Medicare (plans) | $31 | 95% |
| Align Senior Care | $32 | 98% |
| Correctional Recovery | $32 | 98% |
| Hospice Faith | $32 | 98% |
| Hospice Of Holland | $32 | 98% |
| UnitedHealthcare | $33 - $129 | 101% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $36 | 110% |
| Oscar | $40 | 122% |
| Molina Marketplace | $41 | 125% |
| U Of M Health Plan | $49 - $98 | 150% |
| Vitalcore | $49 | 150% |
| Wellpath | $49 | 150% |
| Bcn Domestic | $62 | 189% |
| Blue Benefit Administrators Of Massachusetts | $62 | 189% |
| Blue Care Network | $62 | 189% |
| Blue Distinction Transplant | $62 | 189% |
| Blue Shield - Ca | $62 | 189% |
| Blue Shield - Id (Regence) | $62 | 189% |
| Blue Shield - Ny Highmark Northeastern | $62 | 189% |
| Blue Shield - Ny Highmark Western | $62 | 189% |
| Blue Shield - Pa (Highmark) | $62 | 189% |
| Blue Shield - Wa (Regence) | $62 | 189% |
| Health Choices | $62 - $98 | 189% |
| Kaiser Domestic | $62 | 189% |
| Wc Accident Fund | $70 | 214% |
| Wc Advantage | $70 | 214% |
| Wc Aig | $70 | 214% |
| Wc Allied | $70 | 214% |
| Wc Amerisure | $70 | 214% |
| Wc Amtrust | $70 | 214% |
| Wc Asu Risk Mgt | $70 | 214% |
| Wc Berkley Admin | $70 | 214% |
| Wc Broadspire | $70 | 214% |
| Wc Bunch & Associates | $70 | 214% |
| Wc Ccmsi | $70 | 214% |
| Wc Emc Insurance Company | $70 | 214% |
| Wc Esis | $70 | 214% |
| Wc Fcci | $70 | 214% |
| Wc Federated | $70 | 214% |
| Wc Gallagher Bassett | $70 | 214% |
| Wc Genex Care For Ohio | $70 | 214% |
| Wc Guard Insurance Company | $70 | 214% |
| Wc Hartford | $70 | 214% |
| Wc Liberty Mutual | $70 | 214% |
| Wc Meijers | $70 | 214% |
| Wc Michigan | $70 | 214% |
| Wc Mitchell Frankenmuth | $70 | 214% |
| Wc Pma | $70 | 214% |
| Wc Sedgwick | $70 | 214% |
| Wc Sentry | $70 | 214% |
| Wc Travelers | $70 | 214% |
| Wc Tristar | $70 | 214% |
| Wc Walmart | $70 | 214% |
| Wc Zurich | $70 | 214% |
| Nomi Health | $72 | 220% |
| Acs Benefit Services | $74 | 226% |
| Allied Benefit Systems | $74 | 226% |
| Claimchoice Adminstrators | $74 | 226% |
| Consociate | $74 | 226% |
| Cypress Benefit Administrators | $74 | 226% |
| Forest County Potawatomi | $74 | 226% |
| Health Smart | $74 | 226% |
| Healthgram | $74 | 226% |
| Healthscope | $74 | 226% |
| Secureone Preferred United Plans | $74 | 226% |
| Sisco Benefits | $74 | 226% |
| The Health Plan | $74 | 226% |
| Trustmark Small Business Benefits | $74 | 226% |
| Unified Group Services | $74 | 226% |
| Webtpa | $74 | 226% |
| Priority Health | $76 - $78 | 232% |
| Geha | $81 - $98 | 247% |
| Medical Mutual | $81 | 247% |
| Meritain | $81 | 247% |
| Preferred One | $81 | 247% |
| Asr Health Benefits | $82 | 251% |
| Hap | $82 - $100 | 251% |
| Caresource | $84 | 257% |
| Varipro | $84 | 257% |
| 1199 National Benefit Fund | $94 | 287% |
| Allied National Global Care | $94 | 287% |
| Asrm - Reliance Standard Life Insurance | $94 | 287% |
| Christian Care Ministry | $94 | 287% |
| Cigna | $94 | 287% |
| Dean Health | $94 | 287% |
| Fallon Health | $94 | 287% |
| Family Life Insurance Company | $94 | 287% |
| Ghc Scw | $94 | 287% |
| Group Pension Administrators | $94 | 287% |
| International Benefit Administrators | $94 | 287% |
| Lifetime Benefit Solutions | $94 | 287% |
| Manhattan Life | $94 | 287% |
| Medi Share | $94 | 287% |
| Multiplan | $94 | 287% |
| Mvp | $94 | 287% |
| Pai | $94 | 287% |
| Pan-American Life | $94 | 287% |
| Paramount Hmo | $94 | 287% |
| Phcs | $94 | 287% |
| Trinity Health Share | $94 | 287% |
| Acclaim | $98 | 299% |
| Administrative Concepts | $98 | 299% |
| Allegeant | $98 | 299% |
| Ameriben | $98 | 299% |
| American Family | $98 | 299% |
| American Healthcare Alliance | $98 | 299% |
| American Republic | $98 | 299% |
| Amerihealth | $98 | 299% |
| Aultcare | $98 | 299% |
| Automated Benefit Services | $98 | 299% |
| Auxiant | $98 | 299% |
| Benefit Administrative Systems,Llc | $98 | 299% |
| Boon Chapman | $98 | 299% |
| Cam Administrative Services | $98 | 299% |
| Christian Brother Services | $98 | 299% |
| Christian Brothers Holy Cross | $98 | 299% |
| Comprehensive Benefits | $98 | 299% |
| Continental Life Insurance | $98 | 299% |
| Custom Benefit Administrators | $98 | 299% |
| Employee Benefit Concepts | $98 | 299% |
| Employee Benefit Management | $98 | 299% |
| Enterprise Group Planning | $98 | 299% |
| Freedom Life Insurance Company | $98 | 299% |
| Group Administrators | $98 | 299% |
| Group Marketing Services | $98 | 299% |
| Guardian | $98 | 299% |
| Health America | $98 | 299% |
| Healthez | $98 | 299% |
| Humana | $98 - $129 | 299% |
| Insight | $98 | 299% |
| Intercare | $98 | 299% |
| Jfp Benefit Management | $98 | 299% |
| Jp Farley Corporation | $98 | 299% |
| Key Benefit Administrator | $98 | 299% |
| Liberty Union Life Assurance Co | $98 | 299% |
| Lucent Health | $98 | 299% |
| Luminare Health | $98 | 299% |
| Luminare Health (Detroit) | $98 | 299% |
| Medben | $98 | 299% |
| Medcost | $98 | 299% |
| Mutual Health Services | $98 | 299% |
| Mutual Of Omaha | $98 | 299% |
| Ncas | $98 | 299% |
| Nippon Life Ins | $98 | 299% |
| Nova | $98 | 299% |
| Painters Union Insurance Fund | $98 | 299% |
| Physicians Mutual | $98 | 299% |
| Plumbers Local 98 Insurance Fund | $98 | 299% |
| Prairie States | $98 | 299% |
| Primary Physician Care | $98 | 299% |
| Professional Benefit Administrators | $98 | 299% |
| The Loomis Company | $98 | 299% |
| Unicare | $98 | 299% |
| Us Health And Life | $98 | 299% |
| Valenz | $98 | 299% |
| Western & Southern Financial Group | $98 | 299% |
| Wps | $98 | 299% |
| Coventry | $102 | 312% |
| First Health | $102 | 312% |
| Cmh Allegan County | $129 | 394% |
| Cmh Ausable Valley | $129 | 394% |
| Cmh Barry County | $129 | 394% |
| Cmh Berrien County | $129 | 394% |
| Cmh Cass County | $129 | 394% |
| Cmh Clinton-Eaton-Ingham County | $129 | 394% |
| Cmh Kalamazoo | $129 | 394% |
| Cmh Kent County | $129 | 394% |
| Cmh Lenawee County | $129 | 394% |
| Cmh Misc | $129 | 394% |
| Cmh Monroe County | $129 | 394% |
| Cmh Montcalm County | $129 | 394% |
| Cmh Muskegon County | $129 | 394% |
| Cmh Newaygo County | $129 | 394% |
| Cmh North Country | $129 | 394% |
| Cmh Northern Lakes County | $129 | 394% |
| Cmh Ottawa County | $129 | 394% |
| Cmh Van Buren County | $129 | 394% |
| Cmh West Mi County | $129 | 394% |
| Magellan Behavioral Health | $129 | 394% |